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Sharma G, Gaffey AE, Hameed A, Kasparian NA, Mauricio R, Marsh EB, Beck D, Skowronski J, Wolfe D, Levine GN. Optimizing Psychological Health Across the Perinatal Period: An Update on Maternal Cardiovascular Health: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2025; 14:e041369. [PMID: 39996493 DOI: 10.1161/jaha.125.041369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 01/21/2025] [Indexed: 02/26/2025]
Abstract
Perinatal psychological health conditions (eg, perinatal depression, anxiety) are some of the leading causes of maternal mortality in the United States and are associated with adverse pregnancy outcomes, long-term cardiovascular outcomes, and intergenerational effects on offspring neurodevelopment. These risks underscore the importance of addressing maternal psychological health as a key determinant of perinatal cardiovascular health. Thus, it is vital to recognize the spectrum of perinatal psychological health and to provide guidance for both patients and clinicians on screening and management options across the perinatal period. In this scientific statement from the American Heart Association, we redefine maternal cardiovascular health to include psychological health, provide robust evidence on the association of psychological health with cardiovascular outcomes, highlight the social and environmental underpinnings, and finally, offer guidance about how to integrate psychological health into maternal cardiovascular health with a specific focus on the perinatal period (ie, pregnancy through 1 year postpartum). We also describe opportunities for creating care delivery models that recurrently address perinatal psychological health in cardio-obstetric care, using behavioral and pharmacological interventions, with an emphasis on better integration of psychological health care, longer postpartum follow-up, and opportunities for evaluating the comparative effectiveness of these models with stakeholder partners.
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Chan JKN, Lee KCK, Correll CU, So YK, Chan CY, Wong CSM, Cheung KW, Seto MTY, Lin J, Chang WC. Adverse obstetric and neonatal outcomes associated with maternal schizophrenia-spectrum disorders and prenatal antipsychotic use: a meta-analysis of 37,214,330 pregnancy deliveries and propensity-score weighted population-based cohort study assessing confounder dependency of risk estimates. Mol Psychiatry 2025; 30:954-967. [PMID: 39223277 DOI: 10.1038/s41380-024-02723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
Studies demonstrated increased obstetric and neonatal complications in women with schizophrenia-spectrum disorder (SSD), but most inadequately addressed confounders and rarely considered antipsychotic effects. We conducted a meta-analysis and a population-based cohort study evaluating associations of adverse obstetric/neonatal outcomes with SSD and prenatal antipsychotic use. In the meta-analysis, we searched four databases from inception to October-31-2023 and generated pooled risk estimates using random-effect models. In the cohort study, we identified women aged 15-50 years with SSD-diagnosis from electronic-heath-record database of public healthcare-services who delivered first/singleton children between 2003 and 2018 in Hong Kong. Propensity-score weighted regression-analyses incorporating important confounders including maternal pre-existing and gestational morbidities, substance/alcohol abuse, and psychotropic use, were performed to assess risk of adverse obstetric/neonatal outcomes in SSD-women versus non-SSD-women, and subsequently treated-SSD and untreated-SSD subgroups to disentangle effects of SSD from antipsychotic exposure. The meta-analysis (studies = 18, women = 37,214,330, including 42,926 SSD-women) found significant associations of SSD with 12 of 17 analyzed negative obstetric/neonatal outcomes (with pooled relative risk ranged:1.12-2.10), including placental complications, induced labor, Caesarean delivery, fetal distress, stillbirth, preterm birth, small-for-gestational-age, low birth weight, low APGAR scores, neonatal and post-neonatal deaths. However, the cohort study (466,358 women, including 804 SSD-women) revealed that elevated risk of most study outcomes in unadjusted-models were markedly-attenuated or became non-significant in propensity-score weighted adjusted-models, except index-delivery hospitalization ≥7 days (odds ratio [OR] = 1.76 [95% CI = 1.33-2.34]), preterm birth (OR = 1.48 [95% CI = 1.09-2.00]) and neonatal special-care admission (OR = 1.65 [95% CI = 1.35-2.01]). Apart from higher neonatal special-care admission in treated-SSD than untreated-SSD women (OR = 1.75 [95% CI = 1.23-2.52]), no significant between-group differences emerged in other outcomes. In sum, elevated risk of most obstetric/neonatal complications reported in SSD-women might largely be explained by maternal physical comorbidities, substance/alcohol use disorders and other confounders. Interventions targeting modifiable maternal risk factors should be incorporated in prenatal care for SSD-women to minimize avoidable adverse outcomes.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Krystal Chi Kei Lee
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Yuen Kiu So
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ching Yui Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mimi Tin-Yan Seto
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jessie Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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Yoshino Y, Yagi T, Tsubouchi K, Takaishi Y, Ozaki Y, Iga J, Matsubara K, Matsubara Y, Uchikura Y, Sugiyama T, Ueno S. Effects of Psychotropic Medications Taken by Pregnant Women on Newborn Medical Condition and Lactation Method. Neuropsychopharmacol Rep 2025; 45:e70005. [PMID: 39887672 PMCID: PMC11781817 DOI: 10.1002/npr2.70005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 01/16/2025] [Accepted: 01/21/2025] [Indexed: 02/01/2025] Open
Abstract
BACKGROUND Maternal psychiatric condition during the perinatal period is relevant to children's cognitive development and mental health. Psychotropic medications are necessary to maintain the mental health of pregnant women with psychiatric disorders, but they are often avoided due to concerns about adverse effects, such as congenital malformations and abnormal neurodevelopment. A retrospective study of pregnant women with psychiatric disorders using psychotropic medications was performed to clarify maternal and child demographic data and to investigate whether psychotropic medications affected the Apgar score and the decision to breastfeed. METHODS Data of pregnant women with psychiatric disorders who were referred from the Department of Obstetrics and Gynecology to the Department of Neuropsychiatry at Ehime University Hospital from January 2014 to December 2022 were collected retrospectively. Pearson's chi-squared test and multiple regression analysis were used for statistical analyses. RESULTS A total of 226 women were included; 194 gave birth at our hospital, of whom 79 (40.7%) were taking psychotropic drugs at the time of delivery. None of the children had malformations. There was no relationship between the use of psychotropic medications and the choice to breastfeed. Multiple regression analysis showed that only the gestational weeks at birth were significantly associated with birth weight (p < 0.001) and Apgar score (1 min: p = 0.030; 5 min: p = 0.044). CONCLUSIONS The use of psychotropic medications during the perinatal period appears safe and beneficial for both pregnant women with psychiatric disorders and their children, and breastfeeding should be considered even if the mother continues to take the medication. To clarify these points, prospective studies using large samples from several countries are needed.
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Affiliation(s)
- Yuta Yoshino
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
| | - Toru Yagi
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
| | - Koichi Tsubouchi
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
| | - Yusuke Takaishi
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
| | - Yuki Ozaki
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
| | - Jun‐ichi Iga
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
| | - Keiichi Matsubara
- Department of Obstetrics & GynecologyEhime University School of MedicineToonEhimeJapan
| | - Yuko Matsubara
- Department of Obstetrics & GynecologyEhime University School of MedicineToonEhimeJapan
| | - Yuka Uchikura
- Department of Obstetrics & GynecologyEhime University School of MedicineToonEhimeJapan
| | - Takashi Sugiyama
- Department of Obstetrics & GynecologyEhime University School of MedicineToonEhimeJapan
| | - Shu‐ichi Ueno
- Department of Neuropsychiatry, Molecules and FunctionEhime University Graduate School of MedicineToonEhimeJapan
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Vilaseca B, Roca-Lecumberri A, García-Gibert C, Forte F, Torres-Giménez A, Solé E, Andrés-Perpiñá S, Barajas A, Gelabert E. The impact of severe mental disorders on mother-infant interaction: a systematic review. Arch Womens Ment Health 2025:10.1007/s00737-025-01561-6. [PMID: 39912888 DOI: 10.1007/s00737-025-01561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 01/22/2025] [Indexed: 02/07/2025]
Abstract
PURPOSE Mother-Infant Interaction (MII) is the first dynamic relationship that focuses on both mother-infant involvement and dyadic coordination and is associated with infant development. The main objective of this review is to summarize the evidence on the quality of MII in mothers with Severe Mental Illness (SMI). METHOD A systematic search for cross sectional, cohort or case control studies has been carried out in PubMed, Web of Science, PsycINFO and Scopus to extract studies addressing the relationship between the quality of MII and SMI. RESULTS A total of 15 studies with a sample of 992 women were included. Studies showed worst outcomes for MII in mothers with psychotic disorder and bipolar disorder. The impairments were more pronounced in psychotic disorders. CONCLUSIONS There is evidence of impaired MII in SMI. Social cognition (SC) is essential for understanding and responding to infant cues, so it could partially explain the associations between SMI and interaction outcomes. The current evidence is limited due to substantial heterogeneity and methodological limitations in the studies. Therefore, such findings should be interpreted with caution.
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Affiliation(s)
- Berta Vilaseca
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
| | - Alba Roca-Lecumberri
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina García-Gibert
- Sexual and Reproductive Health Care Assistance Center, Parc Sanitari Sant Joan de Deu, Cerdanyola del Vallès, Spain
| | - Florencia Forte
- Bipolar and Depressive Disorders Unit, Hospital Clinic of Barcelona, Institute of Neurosciences, IDIBAPS, University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM - ISCIII), Barcelona, Spain
| | - Anna Torres-Giménez
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Eva Solé
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Susana Andrés-Perpiñá
- Unitat de Salut Mental Perinatal CLINIC-BCN, Hospital Clínic, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center for Mental Health Network (CIBERSAM - ISCIII), Barcelona, Spain
- Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Ana Barajas
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Serra Húnter Programme, Generalitat de Catalunya, Barcelona, Spain
| | - Estel Gelabert
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.
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Etchecopar-Etchart D, Rahmati M, Yon DK, Smith L, Boyer L, Fond G. Maternal and neonatal complications of pregnant women with bipolar disorder: a systematic review and meta-analysis. EClinicalMedicine 2025; 79:103007. [PMID: 39802306 PMCID: PMC11718293 DOI: 10.1016/j.eclinm.2024.103007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 11/27/2024] [Accepted: 11/27/2024] [Indexed: 01/16/2025] Open
Abstract
Background Confidence in pregnancy outcome data for women with bipolar disorder is compromised by small cohort sizes. However, comprehensive national data have been published over the last decade, but no quantitative synthesis has been established to determine the factors associated with complications in these women. Our goal is to summarise the evidence of population-based data on obstetric complications and neonatal outcomes in women with bipolar disorder compared to women without bipolar disorder. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive search was conducted of PubMed/MEDLINE, Embase, PsycINFO, Web of Science, and Google Scholar from inception to September 26th, 2024. Thirty-six outcomes were extracted from eligible articles for consideration. The study protocol was registered on PROSPERO (CRD42023369031). Findings Fourteen population-based retrospective cohort studies from six high-income countries (Australia, Canada, Hong-Kong, Sweden, Taiwan, and USA) involving 47,954 women with bipolar disorder and their newborns compared to 11,896,577 women without bipolar disorder, published between 2005 and 2024, were identified. During pregnancy, women with bipolar disorders seemed to exhibit an increased risk of gestational diabetes OR = 1.46, (95% Confidence Interval [1.06-2.03]; I2 = 87%), gestational hypertension OR = 1.19 (95% CI [1.02-1.40]; I2 = 41%), antepartum haemorrhage OR = 2.02 (95% CI [1.30-3.13]; I2 = 67%), and pre-eclampsia or eclampsia OR = 1.20 (95% CI [1.05-1.36]; I2 = 67%). At delivery, women with bipolar disorder were observed to face a higher risk of caesarean section OR = 1.35 (95% CI [1.26-1.45]; I2 = 56%), and postpartum haemorrhage OR = 1.39 (95% CI [1.20-1.62]; I2 = 0%). Their newborns also appear to be at high risks of very prematurity OR = 1.84 (95% CI [1.32-2.57]; I2 = 74%), infant death OR = 1.77 (95% CI [1.01-3.13]; I2 = 41%), low birth weight OR = 1.54 (95% CI [1.19-1.99]; I2 = 70%), preterm birth OR = 1.49 (95% CI [1.29-1.72]; I2 = 87%), small for gestational age OR = 1.28 (95% CI [1.14-1.45]; I2 = 57%), and congenital malformations OR = 1.29 (95% CI [1.09-1.53]; I2 = 42%). According to the AMSTAR 2 tool, these results correspond to moderate-quality evidence. Interpretation Despite substantial heterogeneity observed, our findings suggest the presence of a broad spectrum of complications that may affect both pregnant women with bipolar disorder and their newborns. These results can serve as a basis for the development of guidelines for the prevention and management of these complications. We need additional data from other countries, particularly from low-to-moderate income countries. Funding The 'Jeunes Espoirs de la Psychiatrie' (Young Hopes of Psychiatry) doctoral programme is supported by the Fondamental Foundation and sponsored by the Bettencourt Schueller Foundation.
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Affiliation(s)
- Damien Etchecopar-Etchart
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- FondaMental Foundation, Creteil, France
- Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression Résistante FondaMental, CH Charles Perrens, Bordeaux, France
| | - Masoud Rahmati
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Laurent Boyer
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Assistance publique des Hôpitaux de Marseille AP-HM, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Guillaume Fond
- UR3279, CEReSS, Research Centre on Health Services and Quality of Life, Aix Marseille University, Marseille, France
- Assistance publique des Hôpitaux de Marseille AP-HM, Marseille, France
- FondaMental Foundation, Creteil, France
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Momen NC, Chatwin H, Holde K, Liu X, Munk-Olsen T, Madsen KB, Petersen LV. Maternal mental disorders and neonatal outcomes: Danish population-based cohort study. Br J Psychiatry 2025; 226:31-38. [PMID: 39376122 PMCID: PMC11781859 DOI: 10.1192/bjp.2024.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/28/2024] [Accepted: 06/17/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Previous studies have indicated associations between maternal mental disorders and adverse birth outcomes; however, these studies mainly focus on certain types of mental disorders, rather than the whole spectrum. AIMS We aimed to conduct a broad study examining all maternal mental disorder types and adverse neonatal outcomes which is needed to provide a more complete understanding of the associations. METHOD We included 1 132 757 liveborn singletons born between 1997 and 2015 in Denmark. We compared children of mothers with a past (>2 years prior to conception; n = 48 646), recent (2 years prior to conception and during pregnancy; n = 15 899) or persistent (both past and recent; n = 10 905) diagnosis of any mental disorder, with children of mothers with no mental disorder diagnosis before the index delivery (n = 1 057 307). We also considered different types of mental disorders. We calculated odds ratios and 95% CIs of low birthweight, preterm birth, small for gestational age, low Apgar score, Caesarean delivery and neonatal death. RESULTS Odds ratios for children exposed to past, recent and persistent maternal mental disorders suggested an increased risk for almost all adverse neonatal outcomes. Estimates were highest for children in the 'persistent' group for all outcomes, with the exception of the association between persistent maternal mental disorders and neonatal death (odds ratio 0.96, 0.62-1.48). CONCLUSIONS Our study provides evidence for increased risk of multiple adverse neonatal outcomes among children of mothers with mental disorders, highlighting the need for close monitoring and support for women with mental disorders.
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Affiliation(s)
- Natalie C. Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Hannah Chatwin
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Katrine Holde
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Trine Munk-Olsen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Joseph-Delaffon K, Eletri L, Dechartres A, Nordeng HME, Richardson JL, Elefant E, Mitanchez D, Marin B. Neonatal outcomes after in utero exposure to antipsychotics: a systematic review and meta-analysis. Eur J Epidemiol 2024; 39:1073-1096. [PMID: 39352602 DOI: 10.1007/s10654-024-01156-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 08/27/2024] [Indexed: 11/27/2024]
Abstract
Adverse neonatal outcomes following in utero antipsychotic exposure remain unclear. This systematic review and meta-analysis aimed to investigate associations between in utero first- and second-generation antipsychotic exposure and various neonatal outcomes. The primary outcome was small for gestational age. Secondary outcomes included other birth weight-related measures, prematurity and neonatal outcomes. MEDLINE, EMBASE, CENTRAL, ICTRP, and ClinicalTrials.gov were searched for on 8th July 2023. Two reviewers independently selected studies reporting associations between exposure and neonatal outcomes (all designs were eligible, no language or time restriction) and extracted data. ROBINS-I was used for risk of bias assessment. Meta-analyses were performed. Measures of association were odds ratios and mean differences. Thirty-one observational studies were included. Regarding small for gestational age < 10th percentile, meta-analysis was only performed for second-generation antipsychotics and showed no evidence for an association (OR 1.31 [95%CI 0.83; 2.07]; I²=46%; phet=0.13, n = 4 studies). First-generation antipsychotics were associated with an increased risk of small for gestational age < 3rd percentile (OR 1.37 [95%CI 1.02; 1.83]; I²=60%; phet=0.04, n = 5) and a lower mean birthweight (MD -135 g [95%CI -203; -66]; I²=53%; phet=0.07, n = 5). Second-generation antipsychotics were associated with large for gestational age > 97th percentile (OR 1.56 [95%CI 1.31; 1.87]; I²=4%; phet=0.37, n = 4) and Apgar score < 7 (OR 1.64 [95%CI 1.09; 2.47]; I²=47%; phet=0.13, n = 4). Both types of antipsychotics were associated with increased risks of preterm birth and neonatal hospitalization. Despite potential confounding in the studies, this systematic review and meta-analysis showed that newborns of mothers using antipsychotics during pregnancy are potentially at risk of adverse neonatal outcomes. Data sources: MEDLINE, EMBASE, CENTRAL, ICTRP, ClinicalTrials.gov. Prospero Registration Number CRD42023401805.
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Affiliation(s)
- Kristen Joseph-Delaffon
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Trousseau, Centre de Référence sur les Agents Tératogènes (CRAT), Paris, F75012, France
| | - Lina Eletri
- Department of Neonatology, Centre Hospitalier du Mans, Le Mans, 72037, France
| | - Agnès Dechartres
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Unité de Recherche Clinique PSL-CFX, AP-HP, Hôpital Pitié Salpêtrière, Paris, CIC-1901, 75013, France
| | - Hedvig Marie Egeland Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
| | - Jonathan Luke Richardson
- UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Health Security Agency, Newcastle upon Tyne, UK
| | - Elisabeth Elefant
- Département de Santé Publique, AP-HP. Sorbonne Université, Hôpital Trousseau, Centre de Référence sur les Agents Tératogènes (CRAT), Paris, F75012, France
| | - Delphine Mitanchez
- Department of Neonatology, Bretonneau Hospital, François Rabelais University, Tours, F-37000, France.
- INSERM UMR_S 938 Centre de Recherche Saint Antoine, Paris, F-75012, France.
| | - Benoit Marin
- Département de Santé Publique, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Trousseau, Centre de Référence sur les Agents Tératogènes (CRAT), Paris, F75012, France
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Chan JKN, Hung SC, Lee KCK, Cheung KW, Seto MTY, Wong CSM, Lin J, Chang WC. Risk of adverse pregnancy, delivery and neonatal outcomes associated with bipolar disorder and prenatal use of mood stabilizers: A population-based cohort study. Psychiatry Res 2024; 339:116050. [PMID: 38914040 DOI: 10.1016/j.psychres.2024.116050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/26/2024]
Abstract
Previous research examining bipolar-disorder (BD) and pregnancy/neonatal outcomes yielded mixed results, were mostly derived from Western countries and rarely delineated effect between disorder and mood-stabilizers. This population-based study identified women age 15-50 years who delivered first/singleton child in 2003-2018 in Hong Kong, utilizing territory-wide medical-record database of public healthcare services. Propensity-score weighted logistic-regression analyses adjusted for confounders were employed to examine risk of adverse pregnancy, delivery and neonatal outcomes associated with BD and mood-stabilizers (lithium, anticonvulsants and antipsychotics). Exploratory unadjusted-analyses were conducted to assess risk for congenital-malformations. Of 465,069 women, 302 had BD-diagnosis, including 168 redeemed ≥ 1 prescription of mood-stabilizers during pregnancy (treated-BD) and 134 gestationally-unexposed to mood-stabilizers (untreated-BD). BD was significantly-associated with increased risk of gestational-diabetes (adjusted-odds-ratio: 1.75 [95 % CI: 1.15-2.70]) and maternal somatic hospitalization ≤ 90 days post-discharge from index-delivery (2.12 [1.19-3.90]). In treatment status-stratified analyses, treated-BD women exhibited significantly-increased rate of gestational-diabetes (2.09 [1.21-3.70]) relative to controls (non-BD and gestationally-unexposed to mood-stabilizers). No significant association of BD or mood-stabilizers with other adverse outcomes was observed. Overall, our findings indicate that BD and mood-stabilizers are not associated with most adverse pregnancy, delivery and neonatal outcomes. Further research clarifying comparative safety of individual mood-stabilizing agents on pregnancy/neonatal outcomes is required.
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Affiliation(s)
- Joe Kwun Nam Chan
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Samson Chun Hung
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Krystal Chi Kei Lee
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Ka Wang Cheung
- Department of Obstetrics and Gynaecology, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Mimi Tin-Yan Seto
- Department of Obstetrics and Gynaecology, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong
| | - Jessie Lin
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, School of Clinical medicine, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Science, the University of Hong Kong, Hong Kong.
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Misgana T, Gebremichael B, Weldesenbet AB, Tesfaye D, Tamiru D, Tariku M, Alemu D, Dheresa M. Association between antenatal common mental disorders symptoms, and adverse obstetric and perinatal outcomes: A community-based prospective cohort study in Eastern Ethiopia. J Affect Disord 2024; 355:31-39. [PMID: 38548209 DOI: 10.1016/j.jad.2024.03.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Maternal common mental disorders have broad implications for maternal and child mental and physical health that may have a long-lasting social and economic impact. This study aimed to assess the association between symptoms of antenatal common mental disorders and obstetric and perinatal outcomes in Eastern Ethiopia. METHODS A community-based prospective cohort study was conducted and a total of 1011 randomly selected pregnant women were followed up from February 1, 2021, to January 30, 2022. The modified Poisson regression model with a robust variance was fitted to examine the effect of the symptoms of antenatal common mental disorders on obstetric and perinatal outcomes. RESULTS Antenatal common mental disorders (SRQ ≥ 6) were presented among 390 (38.58 %) pregnant women. In the final multivariate Poisson regression model, women with antenatal common mental disorders symptoms had an increased risk of some pregnancy complications (ARR = 1.65, 95 % CI: 1.59, 1.84). In the current study, symptoms of antenatal common mental disorders increased also the risk of preterm birth (ARR = 1.71; 95 % CI: 1.20, 2.42) and low birth weight (ARR = 1.93; 95 % CI: 1.36, 2.74). LIMITATION The indirect effects of some potential mediators and moderators were not assessed in this study. CONCLUSION The study found a high rate of symptoms of antenatal common mental disorders and adverse obstetric and perinatal outcomes. Antenatal common mental disorders symptoms may have considerable effects on individual and combined pregnancy complications and adverse perinatal outcomes.
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Affiliation(s)
- Tadesse Misgana
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Berhe Gebremichael
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dejene Tesfaye
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Tamiru
- Department of Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mandaras Tariku
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Daniel Alemu
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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10
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Su X, Sun L. Prevalence and associated factors of abortion among women with severe mental disorders. J Affect Disord 2024; 355:432-439. [PMID: 38548200 DOI: 10.1016/j.jad.2024.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/23/2024] [Accepted: 03/23/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Abortion behaviors among individuals with mental disorders presented major obstacles to women's health. However, few studies reported the prevalence and associated factors of abortion among women with severe mental disorders in China. Consequently, this study aims to investigate the prevalence of abortion among female patients in rural communities and identify potential health risks. METHOD This was a cross-sectional study of 276 women aged 18 years and older with severe mental disorders in rural areas of Shandong Province, China. The pregnancy history, abortion history and socio-demographic characteristics of women were investigated by questionnaire. Logistic regression analysis was employed to examine the associated factors for different abortion behaviors. RESULT The study showed that 82.61 % (228/276) of patients had a pregnancy history. Among the patients with a pregnancy history, 43.42 % (99/228) reported having had at least one abortion, and 15.79 % (36/228) had more than one. In the other side, 31.58 % (72/228) of them experienced spontaneous abortion, while 12.72 % (29/228) experienced induced abortion. Age at first gestation (aOR 0.80, 95 % CI 0.70-0.90) and age at last gestation (aOR 1.17, 95 % CI 1.07-1.27) were both associated with abortion. Anxiety was related to spontaneous (aOR 1.08, 95 % CI 1.02-1.15) and repeat abortions (aOR 1.10, 95 % CI 1.01-1.19). In addition, religion (aOR 10.47, 95 % CI 2.81-39.01), number of children≥2 (aOR 0.18, 95 % CI 0.04-0.77), and family functioning (aOR 1.31, 95 % CI 1.06-1.63) were associated with induced abortion. CONCLUSION Women with severe mental disorders in rural regions have notably higher rates of abortion compared to the general female population, particularly for spontaneous abortions. Gestational age and anxiety of pregnant patients deserve attention and preventive measures to avoid the outcomes of abortion.
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Affiliation(s)
- Xiaoying Su
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC), Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China
| | - Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; National Health Commission of China (NHC), Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan 250012, China.
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11
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Schonewille NN, Jonkman NH, van Kempen AAMW, van Pampus MG, van den Heuvel OA, Broekman BFP. Pregnancy intention in relation to maternal and neonatal outcomes in women with versus without psychiatric diagnoses. Acta Psychiatr Scand 2024; 149:110-123. [PMID: 37933529 DOI: 10.1111/acps.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/04/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Studies have identified adverse maternal and neonatal outcomes for women with psychiatric disorders. Additionally, psychiatric disorders may pose an increased risk for unintended pregnancies (UPs) which in turn may also impact negatively on outcomes. The present study aims to compare the incidence of UPs in women with versus without current/past psychiatric diagnoses and investigates whether psychiatric history modifies the relation between delivery outcomes in women with and without UPs. METHODS A retrospective cohort was compiled of women who gave birth in a large hospital in Amsterdam, the Netherlands. Women ≥18 years old with singleton pregnancies and birth registrations in the electronic patient file during January 1, 2015 to March 1, 2020 were included. Patient characteristics (including pregnancy intention and psychiatric history), maternal (gestational diabetes, mode of delivery) and neonatal outcomes (e.g., gestational age [GA], birthweight and Apgar scores) were registered by health care providers in hospital charts. Incidence of UPs was compared between women with versus without current/past psychiatric diagnoses. Maternal and neonatal outcomes were compared between women with versus without UPs with linear or logistic regression models adjusted for relevant confounders with an interaction term for UP with current/past psychiatric diagnoses. RESULTS We included 1219 women with and 1093 women without current/past psychiatric diagnoses. Current/past psychiatric diagnoses were significantly associated with UPs after adjustment for confounders (39.0% vs. 29.6%, OR 1.56, CI 1.23-2.00, p < 0.001). In sub-analyses, women with depressive (OR 1.67, CI 1.24-2.26, p = 0.001), personality (OR 2.64, CI 1.38-5.11, p = 0.004) and substance-related and addictive disorders (OR 4.29, CI 1.90-10.03, p = 0.001) had higher odds of UPs compared to women without current/past psychiatric diagnoses. Amongst women with UPs, current/past psychiatric diagnoses did not modify maternal or neonatal outcomes, except for GA at delivery as women with both UPs and current/past psychiatric diagnosis had a 2.21-day higher mean GA at delivery than women in the reference group (p-value interaction = 0.001). CONCLUSIONS Current/past psychiatric diagnoses are associated with a higher odd of UPs. In our sample, maternal and neonatal outcomes were comparable for women with and without UPs and these results were similar for women with and without current/past psychiatric diagnoses, except for GA at delivery. Although our study is limited by several factors, we found that women with current/past psychiatric diagnoses, irrespective of pregnancy planning status, do not have more adverse maternal or pregnancy outcomes. Increased efforts are needed to ensure that psychoeducation and conversations about pregnancy planning and UPs are available for women with current/past psychiatric diagnoses.
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Affiliation(s)
- Noralie N Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | | | - Maria G van Pampus
- Department of Gynaecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Anatomy & Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Compulsivity, Impulsivity & Attention Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Mental Health Program, Amsterdam Public Health, Amsterdam, The Netherlands
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12
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Almeida OP. Prevalence of mental disorders among older Australians: Contrasting evidence from the 2020-2021 National Study of Mental Health and Wellbeing among men and women and the Health In Men Data Linkage Study. Australas Psychiatry 2023; 31:818-823. [PMID: 37496324 PMCID: PMC11184904 DOI: 10.1177/10398562231191692] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To determine the prevalence of common mental disorders among older Australians included in the Health In Men Data Linkage Study and compare those with the results of the 2020-2021 National Study of Mental Health and Wellbeing (NSMHW). METHOD We used longitudinal record linkage to estimate the prevalence of mental disorders from age 65 years in a random sample of 38173 Australian men aged 65-85 years living in the Perth metropolitan region. Outcome was the proportion of participants affected by depressive episodes or dysthymia, bipolar disorder, anxiety disorder, psychotic disorder and alcohol use disorder. RESULTS Prevalence estimates for participants aged 65-69, 70-74, 75-79, 80-84 and ≥85 years were 0.9%, 2.0%, 3.6%, 5.8% and 12.6% for depressive, 0.2%, 0.3%, 0.4%, 0.4% and 0.7% for bipolar, 0.1%, 0.5%, 1.3%, 2.2%, 6.9% for anxiety, 0.2%, 0.4%, 0.5%, 0.4% and 0.6% for psychotic and 1.2%, 1.7%, 2.1%, 2.2% and 4.2% for alcohol use disorders. CONCLUSIONS In contrast to the NSMHW, our data indicate that the prevalence of depressive and anxiety disorders increases with age, particularly among the older old. We conclude that the NSMHW should not be relied upon to guide planning or policies to address the mental health needs of older Australians.
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Affiliation(s)
- Osvaldo P. Almeida
- Medical School, University of Western Australia, Perth, WA, Australia; and WA Centre for Health & Ageing, University of Western Australia, Perth, WA, Australia
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13
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Tang W, Zhou LJ, Zhang WQ, Jia YJ, Hu FH, Chen HL. Adverse perinatal pregnancy outcomes in women with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2023; 262:156-167. [PMID: 37979419 DOI: 10.1016/j.schres.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 10/29/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Schizophrenia is a severe mental illness that affects a significant proportion of the global population, particularly those of childbearing age. Several studies have attempted to find an association between schizophrenia and obstetric complications, with varying results. OBJECTIVE The primary objective of this systematic review and meta-analyses was to summarize the relationship between maternal schizophrenia and perinatal pregnancy outcomes. DATA SOURCES PubMed, Web of Science and Ovid EMBASE were searched from January 2001 to September 2022 using keywords related to pregnancy, women, schizophrenia. STUDY SELECTION A total of 23 independent studies across 21,253 individuals with schizophrenia were identified and included in the analysis. DATA EXTRACTION The following data were extracted: author, year of publication, country/continent of data collection, study design, demographic characteristics, diagnoses criteria, related complications. Data were analyzed using random-effects pairwise meta-analysis and were reported as prevalence and odd ratios (OR). Statistical heterogeneity was quantified with the I2 statistic. RESULTS The prevalence of adverse perinatal pregnancy outcomes was represented in descending order: cesarean section (26.0 %); labor induction (24.0 %); small for gestational age (10.5 %); gestational diabetes mellitus (9.2 %); preterm birth (9.1 %); low birth weight (7.8 %); preterm rupture of membranes (6.1 %); 1-Minute Apgar Score < 7 (5.6 %); large for gestational age (5.5 %); birth defect (5.4 %); antepartum hemorrhage (4.4 %);preeclampsia/eclampsia (4.8 %); postpartum hemorrhage (3.9 %); 5-Minute Apgar Score < 7 (3.6 %); gestational hypertension (3.3 %); placental abruption (1.0 %); placenta previa (0.6 %); thromboembolic disease (0.4 %); neonatal mortality (0.3 %) (P ≤ 0.05). There was a higher risk of adverse outcomes including gestational diabetes mellitus, preeclampsia/eclampsia, placental abruption, thromboembolic disease, preterm birth, birth defect, 1-Minute Apgar score < 7, small for gestational age, low birth weight and neonatal mortality compared with non-schizophrenia population (P ≤ 0.05). CONCLUSIONS Women with schizophrenia are at higher risk of adverse perinatal pregnancy outcomes. It is imperative that research efforts continue to focus on the reproductive safety of women with schizophrenia during their childbearing years.
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Affiliation(s)
- Wen Tang
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Li-Juan Zhou
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Wan-Qing Zhang
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Yi-Jie Jia
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Fei-Hong Hu
- Master of Medicine, Medical School, Nantong University, Nantong, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, Nantong, China.
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14
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Abdelhafez M, Ahmed K, Ahmed N, Ismail M, Mohd Daud MNB, Ping NPT, Eldiasty A, Amri MFB, Jeffree MS, Kadir F, pg Baharuddin DM, Bolong MFB, Hayati F, BtAzizan N, Sumpat D, Syed Abdul Rahim SS, Abdel Malek EH. Psychiatric illness and pregnancy: A literature review. Heliyon 2023; 9:e20958. [PMID: 37954333 PMCID: PMC10632674 DOI: 10.1016/j.heliyon.2023.e20958] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background Women of reproductive age frequently suffer from psychiatric disorders. The risk of developing anxiety, bipolar, and depressive disorders is especially significant during the perinatal period. Objectives This article aims to identify and discuss the different psychiatric conditions that might affect pregnant women and update the mother's carers about the recent and updated bidirectional relationship between psychiatric disease and adverse pregnancy outcomes, As well as the most updates in diagnostic and management strategies. Methods A thorough analysis of the literature was conducted using database searches in EMBASE, Science Direct, Google Scholar, Scopus, and PubMed to obtain the objectives and aim of the study. Results The presence of maternal mental illness during pregnancy has been linked to preterm delivery, newborn hypoglycemia, poor neurodevelopmental outcomes, and disturbed attachment. Placental anomalies, small-for-gestational-age foetuses, foetal discomfort, and stillbirth are among more undesirable perinatal outcomes. Conclusions Pregnancy-related psychiatric disorders are frequent. The outcomes for pregnant women, infants, and women's health are all improved by proper diagnosis and treatment of psychiatric problems.
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Affiliation(s)
- MohsenM.A. Abdelhafez
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - KarimA.M. Ahmed
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - NashwaA.M. Ahmed
- Department of Orthodontics, Faculty of Dental and Oral Surgery, Ahram Canadian University, Egypt
| | - MohdHamdy Ismail
- Owner and Leading Clinician, Ulti Care Dental Clinics, Cairo, Egypt
| | - Mohd Nazri Bin Mohd Daud
- Family Medicine Unit, Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Nicholas Pang Tze Ping
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - AyaM. Eldiasty
- Department of Dermatology, Helios Saint Johannes Klinikum, Duisburg, Germany
| | - Mohd Fariz Bin Amri
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammad Saffree Jeffree
- Department of Public Health Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Fairrul Kadir
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Dg Marshitah pg Baharuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Mohammed Firdaus Bin Bolong
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Firdaus Hayati
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Nornazirah BtAzizan
- Department of Clinical Pathology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | - Doreen Sumpat
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
| | | | - Ehab Helmy Abdel Malek
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Malaysia
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15
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Kananen A, Bernhardsen GP, Lehto SM, Huuskonen P, Kokki H, Keski-Nisula L. Quetiapine and other antipsychotic medications during pregnancy: a 15-year follow-up of a university hospital birth register. Nord J Psychiatry 2023; 77:651-660. [PMID: 37149788 DOI: 10.1080/08039488.2023.2205852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/15/2023] [Accepted: 04/11/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To survey trends of antipsychotic use during pregnancy and examine the associations between the use of quetiapine or any antipsychotic and adverse obstetric and neonatal outcomes. METHODS Birth register study of 36,083 women who gave birth at Kuopio University Hospital, Finland, between 2002 and 2016. Obstetric and neonatal outcomes between women using quetiapine (N = 152) or any antipsychotic (N = 227) were compared to controls (N = 35,133). RESULTS Altogether 246 (0.7%) women used antipsychotic medications during pregnancy and 153 (62,2%) of these women used quetiapine. Antipsychotic usage increased from 0.4% to 1.0% during the 15-year follow-up. Women using antipsychotics were more likely to smoke, drink alcohol, use illicit drugs, use other psychotropic medications, and have higher pre-pregnancy body mass index. Quetiapine use was associated with higher risk of increased postpartum bleeding in vaginal delivery (aOR 1.65; 95%CI 1.13-2.42), prolonged neonatal hospitalization (≥5 days) (aOR 1.54; 95%CI 1.10-2.15), and higher placental to birth weight ratio (PBW ratio) (aB 0.009; 95%CI 0.002-0.016). Use of any antipsychotic was associated with a higher risk of gestational diabetes mellitus (aOR 1.64; 95%CI 1.19-2.27), increased postpartum bleeding in vaginal delivery (aOR 1.50; 95%CI 1.09-2.07), prolonged neonatal hospitalization (≥5 days) (aOR 2.07; 95%CI 1.57-2.73), and higher PBW ratio (aB 0.007; 95%CI 0.001-0.012). CONCLUSION The use of antipsychotic medications increased among Finnish pregnant women from 2002 to 2016. Pregnant women using antipsychotics appear to have a higher risk for some adverse pregnancy and birth outcomes and may benefit from more frequent maternity care follow-ups.
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Affiliation(s)
- Anniina Kananen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Guro Pauck Bernhardsen
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Soili Marianne Lehto
- R&D department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Pasi Huuskonen
- School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Finnish Institute of Occupational Health, Kuopio, Finland
| | - Hannu Kokki
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
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16
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Baker N, Bick D, Bamber L, Wilson CA, Howard LM, Bakolis I, Soukup T, Chang Y. A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness. MATERNAL & CHILD NUTRITION 2023; 19:e13538. [PMID: 37276241 PMCID: PMC10483956 DOI: 10.1111/mcn.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 06/07/2023]
Abstract
There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs.
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Affiliation(s)
- Natasha Baker
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Louise Bamber
- Child and Maternal Mental Health Team, South London and Maudsley NHS Foundation TrustLondonUK
| | - Claire A. Wilson
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- Child and Maternal Mental Health Team, South London and Maudsley NHS Foundation TrustLondonUK
| | - Louise M. Howard
- Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Ioannis Bakolis
- Department of Biostatistics and Health Informatics & Health Service and Population Research Department, School of Mental Health and Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Tayana Soukup
- Department of Surgery and CancerImperial College LondonLondonUK
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
| | - Yan‐Shing Chang
- Methodologies Research Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College LondonLondonUK
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17
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Valli I, Gonzalez Segura A, Verdolini N, Garcia-Rizo C, Berge D, Baeza I, Cuesta MJ, Gonzalez-Pinto A, Lobo A, Martinez-Aran A, Mezquida G, Pina-Camacho L, Roldan Bejarano A, Mas S, McGuire P, Bernardo M, Vieta E. Obstetric complications and genetic risk for schizophrenia: Differential role of antenatal and perinatal events in first episode psychosis. Acta Psychiatr Scand 2023; 148:81-90. [PMID: 36912272 DOI: 10.1111/acps.13546] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/09/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Obstetric complications (OCs) are key contributors to psychosis risk. However, it is unclear whether they increase psychosis vulnerability independently of genetic risk, in interaction with it, or are a manifestation of psychosis proneness. We examined the role of distinct types of OCs in terms of psychosis risk and tested whether they interact differently with genetic vulnerability, whilst accounting for other known environmental risk factors. STUDY DESIGN 405 participants (219 first episode psychosis patients and 186 healthy volunteers) underwent a comprehensive assessment of OCs, measured using the Lewis-Murray scale and divided into complications of pregnancy, abnormalities of foetal growth and development, and complications of delivery. Participants were compared in terms of history of OCs, polygenic risk score for schizophrenia (PRS-SZ) and interactions between these. RESULTS Both complications of pregnancy and abnormalities of foetal growth were significantly associated with case-control status (p = 0.02 and 0.03, respectively), whereas complications of delivery were not. PRS-SZ showed a significant association with psychosis (p = 0.04), but there were no significant interactions between genetic risk for schizophrenia and OCs, either when these were considered globally or separated based on their timeframe. CONCLUSIONS We observed no significant interaction between genetic and obstetric vulnerability, yet distinct types of OCs may have a different impact on psychosis risk, based on their nature and timeframe. Examining their differential role might clarify their relative contributions to this risk.
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Affiliation(s)
- Isabel Valli
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Alex Gonzalez Segura
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
| | - Norma Verdolini
- Department of Mental Health, Umbria 1 Mental Health Center, Perugia, Italy
| | - Clemente Garcia-Rizo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
| | - Daniel Berge
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Hospital del Mar Medical Research Institute, Barcelona, Spain
- Universitat Pompeu Fabra, MELIS Department, Barcelona, Spain
| | - Inmaculada Baeza
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Manuel J Cuesta
- Department of Psychiatry, Navarra University Hospital, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ana Gonzalez-Pinto
- Department of Psychiatry, Hospital Universitario de Alava, UPV/EHU, BIOARABA, Vitoria, Spain
| | - Antonio Lobo
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Anabel Martinez-Aran
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
- Bipolar and Depressive Unit, Hospital Clinic de Barcelona, Institute of Neurosciences, Barcelona, Spain
| | - Gisela Mezquida
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Laura Pina-Camacho
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- School of Medicine, Complutense University, Madrid, Spain
| | - Alexandra Roldan Bejarano
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | - Sergi Mas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Clinical Foundations, Pharmacology Unit, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
| | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Miquel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Barcelona Clínic Schizophrenia Unit (BCSU), Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
| | - Eduard Vieta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en red de salud Mental (CIBERSAM), Spain
- Institute of Neurosciences, University of Barcelona, Spain
- Bipolar and Depressive Unit, Hospital Clinic de Barcelona, Institute of Neurosciences, Barcelona, Spain
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Valli I, McGuire P. Genetic and obstetric risk in psychosis: Towards a hypothesis-based probe of different noxae. Eur Neuropsychopharmacol 2023; 72:6-8. [PMID: 36958231 DOI: 10.1016/j.euroneuro.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Isabel Valli
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, UK.
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19
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Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 5. Obstet Gynecol 2023; 141:1262-1288. [PMID: 37486661 DOI: 10.1097/aog.0000000000005202] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
PURPOSE To assess the evidence regarding safety and efficacy of psychiatric medications to treat mental health conditions during pregnancy and lactation. The conditions reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, and acute psychosis. For information on screening and diagnosis, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 4, "Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum" (1). TARGET POPULATION Pregnant or postpartum individuals with mental health conditions with onset that may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal-fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines-Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes recommendations on treatment and management of perinatal mental health conditions including depression, anxiety, bipolar disorders, and acute postpartum psychosis, with a focus on psychopharmacotherapy. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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20
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Masters GA, Yuan Y, Li NC, Straus J, Moore Simas TA, Byatt N. Improving front-line clinician capacity to address depression and bipolar disorder among perinatal individuals: a longitudinal analysis of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Arch Womens Ment Health 2023; 26:401-410. [PMID: 37188798 DOI: 10.1007/s00737-023-01324-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Perinatal mood disorders (PMDs) are common, yet many patients are undertreated. The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms is designed to increase clinicians' willingness to address PMDs. We examined utilization of MCPAP for Moms and associations with PMDs treatment, including the more complex bipolar disorder (BD). Analyses of MCPAP for Moms data examined utilization from 7/2014 to 6/2020 and associated treatment outcomes. Participants were clinicians (n = 1006) in obstetrics/gynecology, family medicine, and pediatrics. Encounters included (1) resource and referrals and (2) psychiatric consultations (program psychiatrist consultation with clinicians or patients). Utilization sub-groups were identified using group-based trajectory modeling. Higher utilization of MCPAP for Moms was associated with increased rates of treating PMDs (incidence rate ratio [IRR] = 1.07, 95% CI: 1.06-1.07). Examining by encounter type, psychiatric consultations resulted in more frequent rates of clinicians treating PMDs than resource and referral encounters. Utilization of direct patient consultation was associated with the greatest increase in rates of clinicians treating BD (IRR = 2.12, 95% CI: 1.82-2.41). Clinicians with highest utilization rates of psychiatric consultations longitudinally had strongest predictive associations with providing direct mental healthcare to patients with BD (IRR = 13.5, 95% CI: 4.2-43.2). Utilization of MCPAP for Moms facilitates clinicians' ability to provide mental health treatment to patients.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
| | - Yiyang Yuan
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
| | | | - John Straus
- Massachusetts Behavioral Health Partnership, Beacon Health Options, Boston, MA, USA
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
- UMass Memorial Health Care, Worcester, MA, USA
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA
- UMass Memorial Health Care, Worcester, MA, USA
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21
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Runkle JD, Risley K, Roy M, Sugg MM. Association Between Perinatal Mental Health and Pregnancy and Neonatal Complications: A Retrospective Birth Cohort Study. Womens Health Issues 2023; 33:289-299. [PMID: 36621340 PMCID: PMC10213085 DOI: 10.1016/j.whi.2022.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/30/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the United States, particularly in the Southeastern region, despite high medical costs, maternal morbidity, and infant burden. This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications. METHODS A population-based retrospective birth cohort of childbirth hospitalizations and readmissions was constructed for women in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness, and mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity, hypertensive disorders of pregnancy, gestational diabetes, cesarean section, preterm birth, and low birthweight. RESULTS The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and severe mental illness (0.13%). PMAD was associated with a higher risk of severe maternal morbidity, hypertensive disorders of pregnancy, and cesarean section, as well as a higher risk of preterm birth and low birthweight infants. Severe mental illness was associated with low birthweight, hypertensive disorders of pregnancy, and cesarean section. Pregnant populations with MDP were more at risk for severe maternal morbidity, preterm birth, hypertensive disorders of pregnancy, low birthweight, and cesarean section. Each maternal mental health outcome was associated with an increased risk for hospital readmissions up to 45 days after childbirth. CONCLUSIONS Results demonstrate the escalating burden of PMAD and MDP for pregnant populations over time, with important consequences related to maternal and infant morbidity.
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Affiliation(s)
- Jennifer D Runkle
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina.
| | - Kendra Risley
- North Carolina Institute for Climate Studies, North Carolina State University, Asheville, North Carolina
| | - Manan Roy
- Department of Nutrition and Health Care Management, Appalachian State University, Boone, North Carolina
| | - Margaret M Sugg
- Department of Geography and Planning, Appalachian State University, Boone, North Carolina
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22
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Peedicayil J. Genome-Environment Interactions and Psychiatric Disorders. Biomedicines 2023; 11:biomedicines11041209. [PMID: 37189827 DOI: 10.3390/biomedicines11041209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Environmental factors are known to interact with the genome by altering epigenetic mechanisms regulating gene expression and contributing to the pathogenesis of psychiatric disorders. This article is a narrative review of how the major environmental factors contribute to the pathogenesis of common psychiatric disorders such as schizophrenia, bipolar disorder, major depressive disorder, and anxiety disorder this way. The cited articles were published between 1 January 2000 and 31 December 2022 and were obtained from PubMed and Google Scholar. The search terms used were as follows: gene or genetic; genome; environment; mental or psychiatric disorder; epigenetic; and interaction. The following environmental factors were found to act epigenetically on the genome to influence the pathogenesis of psychiatric disorders: social determinants of mental health, maternal prenatal psychological stress, poverty, migration, urban dwelling, pregnancy and birth complications, alcohol and substance abuse, microbiota, and prenatal and postnatal infections. The article also discusses the ways by which factors such as drugs, psychotherapy, electroconvulsive therapy, and physical exercise act epigenetically to alleviate the symptoms of psychiatric disorders in affected patients. These data will be useful information for clinical psychiatrists and those researching the pathogenesis and treatment of psychiatric disorders.
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Affiliation(s)
- Jacob Peedicayil
- Department of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore 632 002, India
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23
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Pierce M, Di Prinzio P, Dalman C, Abel KM, Morgan VA. Hospital inpatient admissions of children of mothers with severe mental illness: A Western Australian cohort study. Aust N Z J Psychiatry 2023; 57:528-536. [PMID: 35642532 DOI: 10.1177/00048674221100161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Children of parents with mental illness face a number of adversities, potentially contributing to poor health. AIM The aim of this study was to quantify the association between maternal severe mental illness and children's hospital admissions. METHOD Record linkage cohort study of 467,945 children born in Western Australia between 1 January 1980 and 31 December 2001. Follow-up was from age 28 days until fifth birthday. Linked registers captured information on potential confounders. Rate ratios and adjusted rate ratios measured relative change in the numbers of admissions and total days of stay, while rate differences measured absolute change in outcomes. Cause-specific increases were calculated for ICD-9 chapters and for 'potentially preventable' conditions. RESULTS After adjusting for potential confounders, children of mothers with severe mental illness had a 46% relative increased rate in hospital admissions (95% confidence interval = [38%, 54%]) and an absolute increase in 0.69 extra days in hospital per child, per year (95% confidence interval = [0.67, 0.70]). The relative increase in admissions was greatest in the child's first year of life (adjusted rate ratio = 1.76, 95% confidence interval = [1.64, 1.88]; rate difference = 0.32, 95% confidence interval = [0.30, 0.34]). Rates of admissions were increased for a range of causes, particularly injuries, infections and respiratory disease, and for conditions classified as 'potentially preventable'. CONCLUSION Children of mothers with severe mental illness have a substantial excess in hospital use compared to children of well mothers. This vulnerable group should be targeted with interventions to avert preventable morbidity and premature mortality in later life.
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Affiliation(s)
- Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Patsy Di Prinzio
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Christina Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Greater Manchester Mental Health Trust, Manchester, UK
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
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The Patterns of Antipsychotic Use for Pregnant Women Over a 16-year Timeframe in an Australian Principal Referral and Specialist Women and Newborn Hospital. Psychiatr Q 2023; 94:23-32. [PMID: 36536267 DOI: 10.1007/s11126-022-10012-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
The purpose of the study is to analyse the patterns of antipsychotic use for pregnant women in an Australian Principal Referral and Specialist Women and Newborn Hospital. This retrospective, observational study involved an analysis of dispensing data of antipsychotics from 1998 to 2014 extracted from the pharmacy dispensing systems. The study included 282 antipsychotic dispensings in the years 1999 to 2006 and 3041 dispensings in the years 2007 to 2014. Second-generation antipsychotic use during pregnancy increased over time, while first-generation-antipsychotics showed declining trend. The use of quetiapine has increased from 2.9% of total antipsychotic dispensings in 2002 up to 77.9% of total antipsychotic dispensings in 2008. Olanzapine use decreased from 78.1% in 2003 to around 20% since 2006. When comparing the age distribution, there was an increased proportion of patients receiving antipsychotics in the 30-39 age range in the second period of 2007 to 2014 compared to 1999 to 2006. The proportion of women on more than one antipsychotic increased from 5% (n = 8) to 9.8% (n = 81) when comparing between 1999 and 2006 and between 2007 and 2014. Our findings indicate a significant shift in prescribing patterns over the study period, with the increased use of antipsychotics, particularly the emergence of SGAs from 2007, changing trends in the use of specific medications as published findings on their safety profiles becomes evident, and more polypharmacy prescribing.
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MacBeth A, McSkimming P, Bhattacharya S, Park J, Gumley A, St Clair D, Barry SJE. General and age-specific fertility rates in non-affective psychosis: population-based analysis of Scottish women. Soc Psychiatry Psychiatr Epidemiol 2023; 58:105-112. [PMID: 35648175 PMCID: PMC9845143 DOI: 10.1007/s00127-022-02313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 05/18/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Women diagnosed with non-affective psychosis have a lower general fertility rate (GFR) and age-specific fertility rate (ASFR) than women in the general population. Contemporary data on GFR in this group remain limited, despite substantive changes in prescribing and management. We calculated contemporary estimates of the GFR and ASFR for women diagnosed with non-affective psychosis compared with the general population of women without this diagnosis. METHODS A population-based design combined routinely collected historical maternity and psychiatric data from two representative areas of Scotland. Women were included from the NHS Grampian or Greater Glasgow and Clyde areas and were aged 15-44 between 2005 and 2013 inclusive. The 'exposed' group had a diagnosis of non-affective psychosis (ICD-10 F20-F29) and was compared to the general population of 'unexposed' women in the same geographical areas. RESULTS Annual GFR between 2005 and 2013 for women with non-affective psychosis varied from 9.6 to 21.3 live births/1000 women per year in the exposed cohort and 52.7 to 57.8 live births/1000 women per year in the unexposed cohort, a rate ratio (RR) of 0.28 [p < 0.001; 95% CI (0.24, 0.32)]. ASFR for all 5-year age groups was lower in the exposed cohort than amongst unexposed women. CONCLUSION We highlight continued low fertility rates in women with a diagnosis of non-affective psychosis, despite widespread availability of prolactin-sparing atypical antipsychotics. Accurate estimation of fertility rates remains crucial in developing needs-matched perinatal care for these women. Methodological improvements using routine datasets to investigate perinatal mental health are also urgently needed.
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Affiliation(s)
- Angus MacBeth
- University of Edinburgh, Edinburgh, Scotland, UK.
- School of Health in Social Science, The University of Edinburgh, Rm 2.11, Doorway 6, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
| | - Paula McSkimming
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - John Park
- NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Andrew Gumley
- Mental Health and Wellbeing, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Sarah J E Barry
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, Scotland, UK
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26
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Davis WA, Bruce DG, Starkstein SE, Davis TME. Temporal Trends in Mortality Associated with Comorbid Type 2 Diabetes and Schizophrenia: The Fremantle Diabetes Study. J Clin Med 2022; 12:jcm12010300. [PMID: 36615099 PMCID: PMC9820984 DOI: 10.3390/jcm12010300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In Phase I of the community-based Fremantle Diabetes Study (FDS1), there was evidence of a deleterious interactive effect of schizophrenia and type 2 diabetes on mortality. Our aim was to investigate whether the mortality gap had improved in FDS Phase II (FDS2) conducted 15 years later. METHODS Participants with type 2 diabetes from FDS1 (n = 1291 recruited 1993-1996) and FDS2 (n = 1509 recruited 2008-2011) were age-, sex- and postcode-matched 1:4 to people without diabetes. Schizophrenia at entry and incident deaths were ascertained from validated administrative data. RESULTS Schizophrenia affected 50/11,195 (0.45%) of participants without diabetes and 17/2800 (0.61%) of those with type 2 diabetes (p = 0.284). During 142,304 person-years of follow-up, the mortality rate (95% CI) was lowest for the FDS2 subgroup without diabetes/schizophrenia (18.2 (16.9, 19.6)/1000 person-years) and highest in FDS2 and FDS1 subgroups with type 2 diabetes/schizophrenia (53.3 (14.5, 136.6) and 98.0 (31.8, 228.8)/1000 person-years, respectively). Compared to the respective FDS subgroup without diabetes/schizophrenia, the mortality rate ratio was approximately 50% higher in the type 2 diabetes subgroup, and three times higher in those with type 2 diabetes/schizophrenia. In Cox regression, unadjusted hazard ratios were highest in those with type 2 diabetes/schizophrenia in FDS1 (HR (95% CI): 3.71 (1.54, 8.93) and FDS2 (2.96 (1.11, 7.91)), increasing to 5.61 (2.33, 13.5) and 26.9 (9.94, 72.6), respectively, after adjustment for age. CONCLUSIONS Although limited by small numbers of schizophrenia cases, these data suggest that comorbid type 2 diabetes and schizophrenia remains associated with a substantial and possibly increasing mortality gap.
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27
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Dai J, Gui Z, Fan X, Liu J, Han L, Sun Y, Shen N, Bai J, Liu Y. Effects of psychiatric disorders on ultrasound measurements and adverse perinatal outcomes in Chinese pregnant women: A ten-year retrospective cohort study. J Psychiatr Res 2022; 156:361-371. [PMID: 36323138 DOI: 10.1016/j.jpsychires.2022.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/12/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Placental health and serial fetal ultrasound parameters deficits in fetal development in women with psychiatric disorders have yet to be understood. This study aimed to examine the effects of psychiatric disorders on placental health, ultrasound measurements, and adverse perinatal outcomes among Chinese pregnant women. METHODS All the pregnant women with psychiatric disorders who delivered at Women's Hospital School of Medicine, Zhejiang University, China, between 2010 and 2020 were included. A total of 992 women (716 in the healthy control group and 276 in the psychiatric disorders group) were recruited. Outcomes include maternal and neonatal birth outcomes. Linear and logistic regression models were used to determine the beta (β) and odds ratios (OR) across 2 models after adjusting for multiple covariates. RESULTS For women with psychiatric diagnoses, the mean placental measurements and serial fetal ultrasound parameters, and neonatal birth weight were lower than general pregnant women. After controlling the use of psychotropic medication during pregnancy, women with psychiatric diagnoses showed higher rates of placental implantation abnormalities or placental adhesion (OR = 5.724, 95% CI = [1.805, 15.408]), gestational diabetes mellitus (OR = 3.861, 95% CI = [2.109, 7.068]), anemia in pregnancy (OR = 4.944, 95% CI = [2.306, 10.598]), preterm birth <37 weeks' gestation (OR = 3.200, 95% CI = [1.702, 6.016]), low birth weight (OR = 11.299, 95% CI = [4.068, 31.386]), and neonatal intensive care unit admission (OR = 3.143, 95% CI = [1.656, 5.962]) compared to women in the healthy control group. CONCLUSION Pregnant women with psychiatric disorders were more likely to have poor placental outcomes, more ultrasound parameter abnormalities and obstetrical complications, and a higher risk for adverse birth outcomes.
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Affiliation(s)
- Jiamiao Dai
- School of Nursing, Wuhan University, Wuhan, China
| | - Zaidi Gui
- School of Nursing, Wuhan University, Wuhan, China; Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoxiao Fan
- School of Nursing, Wuhan University, Wuhan, China
| | - Jun Liu
- School of Nursing, Wuhan University, Wuhan, China
| | - Lu Han
- School of Nursing, Wuhan University, Wuhan, China
| | - Yu Sun
- School of Nursing, Wuhan University, Wuhan, China
| | - Natalie Shen
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Yanqun Liu
- School of Nursing, Wuhan University, Wuhan, China.
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28
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Ogbu-Nwobodo L, Shim RS, Vinson SY, Fitelson EM, Biggs MA, McLemore MR, Thomas M, Godzich M, Mangurian C. Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations. N Engl J Med 2022; 387:1613-1617. [PMID: 36300980 DOI: 10.1056/nejmms2211124] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lucy Ogbu-Nwobodo
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Ruth S Shim
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Sarah Y Vinson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Elizabeth M Fitelson
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - M Antonia Biggs
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Monica R McLemore
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Marilyn Thomas
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Micaela Godzich
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
| | - Christina Mangurian
- From the Department of Psychiatry and Behavioral Sciences (L.O.-N., M.T., C.M.) and the Department of Obstetrics, Gynecology, and Reproductive Sciences (M.A.B.), University of California, San Francisco, San Francisco; the Department of Psychiatry and Behavioral Sciences (R.S.S.) and the Department of Family and Community Medicine (M.G.), University of California, Davis, Sacramento; the Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta (S.Y.V.); the Department of Psychiatry, Columbia University, New York (E.M.F.); and the Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle (M.R.M.)
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Pressman K, Müller R, Krstić N, Običan S. A novel clinic structure for exposure counseling during pregnancy. Birth Defects Res 2022; 114:855-862. [PMID: 35912974 DOI: 10.1002/bdr2.2069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Congenital malformations and adverse fetal outcomes secondary to teratogenic exposures are major public health concerns. We review all inquiries made to the Florida MotherToBaby service center as well as the novel Exposure Clinic, which offers direct patient counseling. METHODS We completed a retrospective review of all inquiries made to the MotherToBaby Florida service and the Exposure Clinic consults between its inception January 2019 through December 2021. All de-identified data was collected at the time of the inquiry and stored in the OTIS database. Aggregate data was then extracted and descriptive statistics were performed. A p value of less than .05 indicated statistical significance. RESULTS In 2019, there were 163 total inquiries, 265 in 2020, and 1,279 in 2021. These 1,707 inquiries covered 2,809 unique exposures. In the Exposure Clinic, 49 patients were seen in 2019, 140 in 2020, and 263 in 2021. The clinic's geographical reach increased over time with patients from 22 different counties being seen in 2021. Of all individual exposures, 45% were evaluated in 452 unique encounters in the Exposure Clinic and 55% were evaluated in 1255 unique encounters via traditional modes of contact. The average number of exposures discussed at each clinic appointment 2.8 versus 1.2 in inquiries via traditional methods. The majority of all exposures were regarding prescription medications, specifically psychiatric medications, followed by immunizations. The exposure with the single most inquiries was the COVID-19 vaccine. CONCLUSIONS This novel clinic structure allows for complex counseling and clinical recommendations regarding exposures during pregnancy.
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Affiliation(s)
- Katherine Pressman
- Department of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Réka Müller
- Department of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Nevena Krstić
- Department of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Sarah Običan
- Department of Obstetrics & Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
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30
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Lefebvre A, Pouchon A, Bioulac S, Mallet J, Polosan M, Dondé C. Management of schizophrenia in women during the perinatal period: a synthesis of international recommendations. Expert Opin Pharmacother 2022; 23:1337-1350. [PMID: 35835161 DOI: 10.1080/14656566.2022.2102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The perinatal period in schizophrenia is associated with high risk of psychotic relapse and pregnancy/child outcomes. The extent to which antipsychotics may potentially affect the fetus or the child development is unclear and debated. Even though guidelines have been developed, there is a lack of consensual recommendations regarding the optimal strategy to manage schizophrenia during the perinatal period. AREAS COVERED This systematic review describes the current state of evidence with respect to the impact of recommended interventions for schizophrenia during the perinatal period, including childbearing age, pregnancy and post-partum. It compares recent international treatment guidelines for this specific group of women. Last, this review presents a set of major points to be discussed with patients and relatives for shared-decision making and a summary of key recommendations from the international guidelines. EXPERT OPINION Although treatment guidelines may be of significant help, discrepancies exist across them regarding the management of antipsychotics for schizophrenia women during the perinatal period. Shared decision-making and advance directives represent useful patient-centered approaches during this specific period. Further cohort-based evidence is needed to better identify maternal and fetal risks associated to antipsychotic treatment exposure.
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Affiliation(s)
| | - Arnaud Pouchon
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Stéphanie Bioulac
- Laboratoire de Psychologie et Neurocognition (CNRS-UMR 5105), Université Grenoble Alpes; Service Psychiatrie de l'enfant et l'adolescent, CHU Grenoble Alpes, France
| | - Jasmina Mallet
- Université de Paris, INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris France; AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, France
| | - Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Clément Dondé
- Univ. Grenoble Alpes, Inserm, U1216, Adult Psychiatry Department CHU Grenoble Alpes, Grenoble Institut Neurosciences, 38000 Grenoble, France; Psychiatry Department, CH Alpes-Isère, F-38000 Saint-Egrève, France
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31
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Law JWY, Chan JKN, Wong CSM, Chen EYH, Chang WC. Antipsychotic utilization patterns in pregnant women with psychotic disorders: a 16-year population-based cohort study. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01453-1. [PMID: 35792919 DOI: 10.1007/s00406-022-01453-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
Despite growing concern about reproductive safety of antipsychotics, there is a paucity of research specifically assessing prenatal antipsychotic prescribing practices for psychotic disorders. This population-based cohort study identified women aged 15-50 years with diagnosis of psychotic disorders, who delivered their first and singleton child between 2003-2018 in Hong Kong, with an aim to examine temporal trends and predictors of prenatal antipsychotic use as well as antipsychotic utilization patterns before and during pregnancy. Data were retrieved from territory-wide medical-record database of public healthcare services. Of 804 women, 519 (65%) redeemed at least one prescription for antipsychotics during pregnancy. Older age at conception (25-34 years: OR 2.12 [95% CI 1.22-3.67]; 35-50 years: 2.52 [1.38-4.61]; 15-24 years as reference category) and antipsychotic treatment within 12 months pre-pregnancy (24.22 [16.23-36.16]) were significantly associated with prenatal antipsychotic use. Second-generation-antipsychotic (SGA) use during pregnancy increased over 16-year study period, while prenatal first-generation-antipsychotic (FGA) use showed declining trend. Overall antipsychotic and SGA use progressively decreased across pre-pregnancy and trimesters of pregnancy. Further analyses on antipsychotic use trajectories revealed that 87.4% (n = 459) of 529 women receiving antipsychotics in 12-month pre-pregnancy redeemed antipsychotic prescription during pregnancy, and 63.4% (n = 333) continued antipsychotic treatment throughout pregnancy. Only 7.5% of the cohort (n = 60) commenced antipsychotics in pregnancy. This is one of the few studies evaluating real-world prenatal antipsychotic utilization among women with psychotic disorders. Future research delineating risk conferred by illness-related factors and antipsychotic exposure on adverse maternal and fetal outcomes is warranted to facilitate treatment guideline development.
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Affiliation(s)
- Jenny Wai Yiu Law
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Joe Kwun Nam Chan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Corine Sau Man Wong
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. .,State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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32
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Masters GA, Xu L, Cooper KM, Moore Simas TA, Brenckle L, Mackie TI, Schaefer AJ, Straus J, Byatt N. Perspectives on addressing bipolar disorder in the obstetric setting. Gen Hosp Psychiatry 2022; 77:130-140. [PMID: 35640435 PMCID: PMC10858616 DOI: 10.1016/j.genhosppsych.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Perinatal Psychiatry Access Programs have emerged to help obstetric professionals meet the needs of perinatal individuals with mental health conditions, including bipolar disorder (BD). We elucidate obstetric professionals' perspectives on barriers and facilitators to managing BD in perinatal patients, and how Access Programs may affect these processes. METHODS We conducted three focus groups with obstetric professionals, two with- and one without-exposure to an Access Program, the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms. Focus groups discussed experiences, barriers, facilitators, and solutions to caring for perinatal individuals with BD. Qualitative data were coded and analyzed by two independent coders; emergent themes were examined across exposure groups. RESULTS Thirty-one obstetric professionals (7 without-exposure, 24 with-exposure) participated. Identified themes included: (1) gaps in perinatal BD education; (2) challenges in patient assessment; (3) MCPAP for Moms as a facilitator for addressing BD; and (4) importance of continued outreach and destigmaization to increase care collaboration. CONCLUSIONS Barriers to obstetric professionals accessing adequate mental healthcare for their patients with BD abound. With psychiatric supports in place, it is possible to build obstetric professionals' capacity to address BD. Perinatal Psychiatry Access Programs can facilitate obstetric professionals bridging these gaps in mental health care.
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Affiliation(s)
- Grace A Masters
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America.
| | - Lulu Xu
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Katherine M Cooper
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Tiffany A Moore Simas
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America; UMass Memorial Health, Worcester, MA, United States of America
| | - Linda Brenckle
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Thomas I Mackie
- SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States of America
| | - Ana J Schaefer
- SUNY Downstate Health Sciences University, School of Public Health, Brooklyn, NY, United States of America
| | - John Straus
- Massachusetts Behavioral Health Partnership, Boston, MA, United States of America
| | - Nancy Byatt
- University of Massachusetts Chan Medical School, Worcester, MA, United States of America; UMass Memorial Health, Worcester, MA, United States of America
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Nguyen T, Frayne J, Watson S, Lebedevs T, Teoh S, Galbally M. Long-acting injectable antipsychotic treatment during pregnancy: Outcomes for women at a tertiary maternity hospital. Psychiatry Res 2022; 313:114614. [PMID: 35576628 DOI: 10.1016/j.psychres.2022.114614] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 10/18/2022]
Abstract
Our study aimed to examine pregnancy, neonatal and psychosocial outcomes for women treated with LAIs at tertiary maternity hospital. A retrospective review of all women who were treated with LAIs between 1999 and 2017. Cases were identified via the hospital dispensary system and outcome data were extracted case notes as well as the midwifery notification system. Measures included sociodemographic data, smoking, alcohol and illicit substance use, pregnancy complications such as gestational diabetes, and neonatal outcomes. Psychosocial profiles such as psychiatric admission during pregnancy and statutory child protection involvement were also assessed. Where available, outcomes were compared with state population data. The study found 38 pregnancies to 36 women, who had LAI treatment. Two congenital malformations (5.7%) were recorded. Compared to general population data, pregnant women treated with LAIs were more likely to have obstetric complications including gestational diabetes and pregnancy hypertension and special care nursery admission for their babies. They also had elevated rates of psychiatric admissions during pregnancy and statutory child protection involvement. Outcomes were similar first and second generation LAIs exposure. As women on LAI have limited options for treatment of their psychotic disorders, the findings point towards a need for enhanced multidisciplinary pregnancy care for this vulnerable cohort.
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Affiliation(s)
- Thinh Nguyen
- School of Medicine, University of Western Australia, Rockingham, Western Australia 6968, Australia; Peel and Rockingham Kwinana Mental Health Service, PO Box 288, Western Australia, Australia.
| | - Jacqueline Frayne
- School of Medicine, University of Western Australia, Rockingham, Western Australia 6968, Australia; Department of Obstetrics, King Edward Memorial Hospital, Western Australia, Australia
| | - Stuart Watson
- Health Futures Institute, Murdoch University, Western Australia, Australia; School of Medicine, University of Notre Dame Fremantle, Western Australia, Australia
| | - Tamara Lebedevs
- Pharmacy Department, King Edward Memorial Hospital, Western Australia, Australia
| | - Stephanie Teoh
- Pharmacy Department, King Edward Memorial Hospital, Western Australia, Australia
| | - Megan Galbally
- School of Medicine, University of Notre Dame Fremantle, Western Australia, Australia; School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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Heinonen E, Forsberg L, Nörby U, Wide K, Källén K. Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study. BMJ Open 2022; 12:e061328. [PMID: 35768086 PMCID: PMC9244682 DOI: 10.1136/bmjopen-2022-061328] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy. DESIGN A population-based register study. SETTING Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants' health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy. PARTICIPANTS The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy. OUTCOME MEASURES The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities. RESULTS Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy. CONCLUSION Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.
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Affiliation(s)
- Essi Heinonen
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Forsberg
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Nörby
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
- Health and Medical Care Administration, Region Stockholm, Stockholm, Sweden
| | - Katarina Wide
- Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Källén
- Department of Clinical Sciences, Centre of Reproduction Epidemiology, Tornblad Institute, Lund University, Lund, Sweden
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Diguisto C, Strachan MWJ, Churchill D, Ayman G, Knight M. A study of diabetic ketoacidosis in the pregnant population in the United Kingdom: Investigating the incidence, aetiology, management and outcomes. Diabet Med 2022; 39:e14743. [PMID: 34778994 PMCID: PMC7612514 DOI: 10.1111/dme.14743] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/19/2021] [Accepted: 11/12/2021] [Indexed: 01/10/2023]
Abstract
AIM To estimate the incidence of diabetic ketoacidosis (DKA) among pregnant women, describe its clinical features, management and outcomes and identify the risk factors for the condition. METHODS A national population-based case-control study was conducted in the UK using the UK Obstetric Surveillance System between April 2019 and September 2020 including all pregnant women with DKA irrespective of the level of blood glucose. The incidence rate of DKA in pregnancy was estimated. A case-control analysis limited to women with type 1 diabetes was performed comparing characteristics of women with DKA (cases) to those of women whose pregnancies were not complicated by DKA (controls). RESULTS In all, 82 women were identified with DKA in pregnancy; 6.3 per 100,000 maternities (95% CI: 5.0-7.9). No maternal deaths occurred, but perinatal mortality was 12/73 (16%) with 11 stillbirths and one neonatal death. DKA episodes mostly occurred in women with type 1 diabetes (85%) and in the 3rd trimester of pregnancy (71%). Episodes were mainly precipitated by infection (21%), vomiting (21%), steroid therapy (13%) and medication errors (10%). Fifteen percent of women had more than one episode of DKA during their pregnancy. Risk factors associated with DKA among women with type 1 diabetes identified through the case-control analysis were the woman and/or partner not being in a paid employment and having at least one microvascular complication of diabetes before pregnancy. CONCLUSION DKA in pregnancy was associated with high perinatal mortality and was linked with factors related to socio-economic deprivation, mental health problems and long-term difficulties with glycaemic control.
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Affiliation(s)
- Caroline Diguisto
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproductionCentre Olympe de GougesCHRU de ToursUniversité de ToursToursFrance
- Université de ParisCRESSINSERMINRAParisFrance
| | | | - David Churchill
- Research Institute in Healthcare ScienceUniversity of WolverhamptonThe Royal Wolverhampton Hospital NHS TrustWolverhamptonUK
| | - Goher Ayman
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Marian Knight
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Davidsen KA, Munk-Laursen T, Foli-Andersen P, Ranning A, Harder S, Nordentoft M, Thorup AAE. Mental and pediatric disorders among children 0-6 years of parents with severe mental illness. Acta Psychiatr Scand 2022; 145:244-254. [PMID: 34351617 DOI: 10.1111/acps.13358] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Parental severe mental illness (SMI) increases the lifetime risk of mental and pediatric disorders in the offspring but little is known about specific disorders during early childhood. The primary aim was to investigate the incidence of mental and pediatric disorders among children 0-6 years old exposed to parental SMI, and secondarily to investigate the distribution of disorders on specific child age. METHODS A nationwide, register-based cohort study of 1,477,185 children born in Denmark between 1994.01.01 and 2016.12.31. Incidence rate ratios were calculated using Poisson regression analysis for any and specific mental and pediatric disorders. RESULTS IRR for any psychiatric disorder was elevated by a factor 2-5 among SMI offspring. Maternal schizophrenia resulted in the highest IRR = 5.23 (4.80-5.69) of any child psychiatric disorder. The risk of anxiety/OCD and attachment disorder among offspring exposed to parental, and in particular maternal, SMI was markedly raised with IRRs for anxiety/OCD between 7.59 and 17.02 and attachment disorders between 6.26 and 15.40. IRRs of mental disorders were highest at age 0-1 year and declined with age. IRR for any pediatric disorder was also elevated with IRRs between 1.01 and 1.28. Disorders of the digestive system and ill-defined symptoms were associated with the highest IRRs. Maternal (vs. paternal) SMI was associated with higher IRRs. IRRs declined slightly with child age. CONCLUSION Children exposed to parental SMI are at increased risk of mental and pediatric disorders during early childhood, particularly anxiety/OCD and attachment disorders. If associations are estimates of a modifiable causal relationship, our results indicate a need for early intervention to promote mental and pediatric health among SMI offspring.
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Affiliation(s)
- Kirstine Agnete Davidsen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Child and Adolescent Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Thomas Munk-Laursen
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Copenhagen, Denmark
| | | | - Anne Ranning
- Mental Health Services Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Harder
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Services Copenhagen, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Child and Adolescent Mental Health Center, Capital Region of Denmark, Copenhagen, Denmark
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37
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Toufeili A, Cohen E, Ray JG, Wilton AS, Brown HK, Saunders NR, Dennis CL, Holloway AC, Morrison KM, Hanley GE, Oberlander TF, Bérard A, Tu K, Barker LC, Vigod SN. Complex chronic conditions among children born to women with schizophrenia. Schizophr Res 2022; 241:24-35. [PMID: 35074529 DOI: 10.1016/j.schres.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 09/28/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Maternal schizophrenia is linked to complications in offspring near the time of birth. Whether there is also a higher future risk of the child having a complex chronic condition (CCC) - a pediatric condition affecting any bodily system expected to last at least 12 months that is severe enough to require specialty care and/or a period of hospitalization - is not known. METHODS In this population-based health administrative data cohort study (Ontario, Canada, 1995-2018), the risk for CCC was compared in 5066 children of women with schizophrenia (the exposed) vs. 2,939,320 unexposed children. Adjusted hazard ratios (aHR) were generated for occurrence of any CCC, by CCC category, and stratified by child sex, and child prematurity. RESULTS CCC was more frequent in the exposed (7.7 per 1000 person-years [268 children]) than unexposed (4.2 per 100 person-years [124,452 children]) - an aHR of 1.25 (95% CI 1.10-1.41). aHRs were notably higher in 5 of 9 CCC categories: neuromuscular (1.73, 1.28-2.33), cardiovascular (1.94, 1.64-2.29), respiratory (1.83, 1.32-2.54), hematology/immunodeficiency (2.24, 1.24-4.05) and other congenital or genetic defect (1.59, 1.16-2.17). The aHR for CCC was more pronounced among boys (1.32, 1.13-1.55) than girls (1.16, 0.96-1.40), and of similar magnitude in term (1.22, 1.05-1.42) and preterm infants (1.18, 0.95-1.46). CONCLUSIONS The risk for a CCC appears to be higher in children born to women with schizophrenia. This finding introduces opportunities for targeted preconception counselling, optimization of maternal risk factors, and intervention to support a vulnerable parent population who will experience unique challenges caring for a child with CCCs.
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Affiliation(s)
- A Toufeili
- Dept. of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Cohen
- Dept. of Pediatrics and Edwin S.H. Leong Centre for Healthy Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - J G Ray
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - H K Brown
- ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - N R Saunders
- Dept. of Pediatrics and Edwin S.H. Leong Centre for Healthy Children, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - C L Dennis
- St. Michael's Hospital, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada; Faculty of Nursing, Toronto, Ontario, Canada
| | - A C Holloway
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - K M Morrison
- Department of Pediatrics, Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - G E Hanley
- Women's College Hospital and Research Institute, Toronto, Ontario, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - T F Oberlander
- University of British Columbia, Vancouver, British Columbia, Canada
| | - A Bérard
- Centre Hospitalier Universitaire Sainte-Justine Research Center, Montreal, Quebec, Canada; Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - K Tu
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada; North York General Hospital, Toronto, Ontario, Canada; Toronto Western Hospital Family Health Team-University Health Network, Toronto, Ontario, Canada
| | - L C Barker
- Dept. of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada
| | - S N Vigod
- Dept. of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Hospital and Research Institute, Toronto, Ontario, Canada.
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Edvardsson K, Hughes E, Copnell B, Mogren I, Vicendese D, Gray R. Severe mental illness and pregnancy outcomes in Australia. A population-based study of 595 792 singleton births 2009-2016. PLoS One 2022; 17:e0264512. [PMID: 35226688 PMCID: PMC8884496 DOI: 10.1371/journal.pone.0264512] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia. METHODS Our sample included all reported live singleton births in Victoria 2009-2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness. RESULTS Of all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37-2.43), having gestational diabetes mellitus (1.57, 1.34-1.84), undergoing an unplanned caesarean section (1.17, 1.02-1.33), induction of labour (1.17, 1.05-1.30) and postpartum haemorrhage (1.15, 1.03-1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43-1.80), a low Apgar score at 5 minutes (1.50, 1.19-1.90), preterm birth (1.40, 1.20-1.63), and low birthweight (1.26, 1.06-1.49). CONCLUSION Women with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.
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Affiliation(s)
- Kristina Edvardsson
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
| | - Elizabeth Hughes
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
| | - Ingrid Mogren
- Judith Lumley Centre, La Trobe University, Bundoora, VIC, Australia
- Department of Clinical sciences, Obstetrics and Gynaecology, Umea University, Umea, Sweden
| | - Don Vicendese
- The Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
- The Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Richard Gray
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
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Fonseca PAS, Schenkel FS, Cánovas A. Genome-wide association study using haplotype libraries and repeated measures model to identify candidate genomic regions for stillbirth in Holstein cattle. J Dairy Sci 2022; 105:1314-1326. [PMID: 34998559 DOI: 10.3168/jds.2021-20936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Abstract
Reduced fertility is one of the main causes of economic losses on dairy farms, resulting in economic losses estimated at $938 per stillbirth case in Holstein herds. The identification of genomic regions associated with stillbirth could help to develop better management and breeding strategies aimed to reduce the frequency of undesirable gestation outcomes. Here, 10,570 cows and 50,541 birth records were used to perform a haplotype-based GWAS. A total of 41 significantly associated pseudo-SNPs (haplotypes within haplotype blocks converted to a binary classification) were identified after Bonferroni adjustment for multiple tests. A total of 117 positional candidate genes were annotated within or close (in a 200-kb interval) to significant pseudo-SNPs (haplotype blocks). The guilt-by-association functional prioritization identified 31 potential functional candidate genes for reproductive performance out of the 117 positional candidate genes annotated. These genes play crucial roles in biological processes associated with pregnancy persistence, fetus development, immune response, among others. These results helped us to better understand the genetic basis of stillbirth in dairy cattle and may be useful for the prediction of stillbirth in Holstein cattle, helping to reduce the related economic losses caused by this phenotype.
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Affiliation(s)
- P A S Fonseca
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - F S Schenkel
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - A Cánovas
- Centre for Genetic Improvement of Livestock, Department of Animal Biosciences, University of Guelph, Guelph, ON N1G 2W1, Canada.
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Antipsychotic Use in Pregnancy: Patient Mental Health Challenges, Teratogenicity, Pregnancy Complications, and Postnatal Risks. Neurol Int 2022; 14:62-74. [PMID: 35076595 PMCID: PMC8788503 DOI: 10.3390/neurolint14010005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 02/01/2023] Open
Abstract
Pregnant women constitute a vulnerable population, with 25.3% of pregnant women classified as suffering from a psychiatric disorder. Since childbearing age typically aligns with the onset of mental health disorders, it is of utmost importance to consider the effects that antipsychotic drugs have on pregnant women and their developing fetus. However, the induction of pharmacological treatment during pregnancy may pose significant risks to the developing fetus. Antipsychotics are typically introduced when the nonpharmacologic approaches fail to produce desired effects or when the risks outweigh the benefits from continuing without treatment or the risks from exposing the fetus to medication. Early studies of pregnant women with schizophrenia showed an increase in perinatal malformations and deaths among their newborns. Similar to schizophrenia, women with bipolar disorder have an increased risk of relapse in antepartum and postpartum periods. It is known that antipsychotic medications can readily cross the placenta, and exposure to antipsychotic medication during pregnancy is associated with potential teratogenicity. Potential risks associated with antipsychotic use in pregnant women include congenital abnormalities, preterm birth, and metabolic disturbance, which could potentially lead to abnormal fetal growth. The complex decision-making process for treating psychosis in pregnant women must evaluate the risks and benefits of antipsychotic drugs.
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Ross NE, Webster TG, Tastenhoye CA, Hauspurg AK, Foust JE, Gopalan PR, Friedman SH. Reproductive Decision-Making Capacity in Women With Psychiatric Illness: A Systematic Review. J Acad Consult Liaison Psychiatry 2022; 63:61-70. [PMID: 34461294 PMCID: PMC8792197 DOI: 10.1016/j.jaclp.2021.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Decision-making capacity can be affected by psychiatric illness. Women who have psychiatric illness who make decisions about their reproductive health may require evaluation of their decision-making capacity. OBJECTIVE This article aims to characterize existing literature about capacity evaluations in women with psychiatric illness making reproductive decisions. METHODS We conducted a systematic review searching PubMed, EMBASE, Ovid PsycINFO, and ClinicalTrials.gov databases through July 2020. Articles were evaluated for relevance to inclusion criteria, first by title and abstract screening then by reading the full text of articles. Our inclusion criteria were case reports and studies that involved women of childbearing age with psychiatric illness making obstetrical decisions for whom decision-making capacity was evaluated. We qualitatively analyzed our data by examining themes within the studies, such as the circumstances of the referral and characteristics of reproductive decision-making. We also collected information about the clinical circumstances, such as the clinical setting (e.g., inpatient or outpatient, in primarily psychiatric or obstetric care) and who made the determination of capacity. RESULTS We identified 18 articles, which included 22 distinct patient cases and 27 distinct obstetrical decisions. Decisions about termination of pregnancy were most common, which were 10 of 27 decisions. Decisions about timing and mode of delivery accounted for 7 and 5 decisions, respectively. The most common psychiatric diagnosis reported was schizophrenia, which was present in 8 patients. Major depression and bipolar disorder were also frequently reported, present in 3 and 5 patients, respectively. CONCLUSION Patients who make health care decisions must have decision-making capacity. A patient with psychiatric illness does not inherently lack capacity, and in fact, most patients with psychiatric illness have decision-making capacity. Psychiatric illness, however, can add complexity to obstetrical medical decision-making. Reasons for this complexity include the involvement of many stakeholders, the often time-sensitive nature of these decisions, and the potentially unpredictable course of psychiatric illness. Successful management of these cases involves multidisciplinary collaboration, the use of preventative ethics through advanced care planning, and identification of a guardian or surrogate decision-maker when a patient is determined to lack decision-making capacity or for a patient who has capacity through advanced care planning. PROSPERO REGISTRATION NUMBER CRD42020143434.
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Affiliation(s)
- Nina E. Ross
- Case Western Reserve University/University Hospitals, Cleveland, OH
| | | | | | - Alisse K. Hauspurg
- Department of Obstetrics, Gynecology & Reproductive Sciences University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jill E. Foust
- Health Sciences Library System, University of Pittsburgh Pittsburgh, PA
| | | | - Susan Hatters Friedman
- Division of Forensic Psychiatry, UH Cleveland Medical Center, The Phillip J. Resnick Professor of Forensic Psychiatry, Professor of Reproductive Biology, Professor of Pediatrics, Adjunct Professor of Law, Case Western Reserve University
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Schizophrenia pregnancies should be given greater health priority in the global health agenda: results from a large-scale meta-analysis of 43,611 deliveries of women with schizophrenia and 40,948,272 controls. Mol Psychiatry 2022; 27:3294-3305. [PMID: 35804094 PMCID: PMC9264309 DOI: 10.1038/s41380-022-01593-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
Abstract
Women with schizophrenia and their newborns are at risk of adverse pregnancy, delivery, neonatal and child outcomes. However, robust and informative epidemiological estimates are lacking to guide health policies to prioritise and organise perinatal services. For the first time, we carried out a systematic review and meta-analysis to synthesise the accumulating evidence on pregnancy, delivery, neonatal complications, and infant mortality among women with schizophrenia and their newborns (N = 43,611) vs. controls (N = 40,948,272) between 1999 and 2021 (26 population-based studies from 11 high-income countries) using random effects. Women with schizophrenia had higher odds (OR) of gestational diabetes (2.35, 95% CI: [1.57-3.52]), gestational hypertension, pre-eclampsia/eclampsia (OR 1.55, 95% CI: [1.02-2.36]; 1.85, 95% CI: [1.52-2.25]), antepartum and postpartum haemorrhage (OR 2.28, 95% CI: [1.58-3.29]; 1.14, 95% CI: [1.04-1.24]), placenta abruption, threatened preterm labour, and premature rupture of membrane (OR 2.20, 95% CI: [2.02-2.39]; 2.91, 95% CI: [1.57-5.40]; 1.29, 95% CI: [1.06-1.58]), c-section (OR 1.33, 95% CI: [1.22-1.45]), foetal distress (OR 1.80, 95% CI: [1.43-2.26]), preterm and very preterm delivery (OR 1.79, 95% CI: [1.62-1.98]; 2.31, 95% CI: [1.78-2.98]), small for gestational age and low birth weight (OR 1.63, 95% CI: [1.48-1.80]; 1.75, 95% CI: [1.46-2.11]), congenital malformations (OR 1.86, 95% CI: [1.71-2.03]), and stillbirths (OR 2.06, 95% CI: [1.83-2.31]). Their newborns had higher odds of neonatal death (OR 1.41, 95% CI: [1.03-1.94]), post-neonatal death (OR 2.87, 95% CI: [2.11-3.89]) and infant mortality (OR 2.33, 95% CI: [1.81-3.01]). This large-scale meta-analysis confirms that schizophrenia is associated with a substantially increased risk of very preterm delivery, stillbirth, and infant mortality, and metabolic risk in mothers. No population-based study has been carried out in low- and middle-income countries in which health problems of women with schizophrenia are probably more pronounced. More research is needed to better understand the complex needs of women with schizophrenia and their newborns, determine how care delivery could be optimised, and define best practices. Study registration: PROSPERO CRD42020197446.
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di Giacomo E, Pessina R, Santorelli M, Rucco D, Placenti V, Aliberti F, Colmegna F, Clerici M. Therapeutic termination of pregnancy and women's mental health: Determinants and consequences. World J Psychiatry 2021; 11:937-953. [PMID: 34888166 PMCID: PMC8613757 DOI: 10.5498/wjp.v11.i11.937] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/27/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women's mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.
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Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
- Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
| | - Rodolfo Pessina
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | - Mario Santorelli
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | - Daniele Rucco
- PhD Program in Psychology, Linguistics and Cognitive Neuroscience, University Milan Bicocca, Milano 20126, Lombardy, Italy
| | - Valeria Placenti
- Psychiatric Residency Training Program, University of Genova, Genova 16126, Liguria, Italy
| | - Francesca Aliberti
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | | | - Massimo Clerici
- School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
- Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
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Zerihun T, Sorsdahl K, Hanlon C. Family planning for women with severe mental illness in rural Ethiopia: a qualitative study. Reprod Health 2021; 18:191. [PMID: 34583725 PMCID: PMC8480012 DOI: 10.1186/s12978-021-01245-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/17/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI), there may be particular challenges and concerns. As primary care-based mental health services are expanding in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Therefore, the present study explored the family planning experiences and preferences of women with SMI who reside in a predominantly rural area of Ethiopia. METHODS A qualitative study was conducted. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively based on their responses to a quantitative survey of current family planning utilisation. In-depth interviews were conducted with 16 women with SMI who were of reproductive age. Audio files were transcribed in Amharic, translated into English and analysed thematically. RESULTS Participants reported pervasive effects of SMI upon the intimate relationships and sexual lives of women. Although women with SMI felt that family planning was important, they had limited knowledge of family planning generally, and a lack of understanding of the specific family planning needs relevant to having SMI. None of the women with SMI in the present study had received any recommendations to use family planning services while accessing mental health care services. The participants identified ways in which primary care-based mental health services could better meet their family planning needs. CONCLUSIONS This study provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.
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Affiliation(s)
- Tigist Zerihun
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
- Department of Psychiatry, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Katherine Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Weisshaupt K, Weichert A, Henrich W, Walter H, Hägele C, Großbölting R. [Psychiatric Patients in Obstetrics in Germany - The Legal Basis and a Thematic Analysis of Case Reports]. Z Geburtshilfe Neonatol 2021; 226:25-33. [PMID: 34492708 DOI: 10.1055/a-1541-8924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The care of adult patients with particularly severe psychiatric illnesses in the daily routine of inpatient obstetrics is rare, but due to its complexity it represents a great challenge for all professions involved. The clinical pictures are very variable. There are a number of interlocking responsibilities in the provision of care. For planning of the birth, the medical-professional cooperation of psychiatry, obstetrics and pediatrics is necessary. Patients are often represented by legal guardians. The Youth Welfare Office is responsible for the welfare of the family and the children. The legal basis is essentially provided by the Civil Code, the Criminal Code and specific state laws, compliance with which is monitored by the courts. Typical psychiatric clinical pictures are presented by means of case reports. Legally defined applications such as accommodation, measures similar to deprivation of liberty, compulsory medical measures and justifiable necessity are explained. In the sense of a thematic analysis, these are applied to the case reports and peripartum management is discussed against the legal background. The precise knowledge of the legal background makes it easier for obstetricians to follow the procedures and interdisciplinary cooperation, especially at perinatalogical centres.
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Affiliation(s)
- Karen Weisshaupt
- Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Alexander Weichert
- Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wolfgang Henrich
- Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Henrik Walter
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Claudia Hägele
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ralf Großbölting
- kwm Berlin - Kanzlei für Wirtschaft und Medizin, Berlin, Deutschland
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O'Sullivan DL, Byatt N, Dossett EC. Long-Acting Injectable Antipsychotic Medications in Pregnancy: A Review. J Acad Consult Liaison Psychiatry 2021; 63:53-60. [PMID: 34461296 DOI: 10.1016/j.jaclp.2021.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Long-acting injectable antipsychotic medications (LAIs) are an evidence-based treatment option for people with severe mental illness. While women with severe mental illness who are prescribed LAIs can become pregnant, there is a dearth of research examining the safety of these medication formulations during pregnancy. OBJECTIVE This article summarizes available literature on the use of LAIs in pregnancy to help inform clinical decisions and guide future research. METHODS PubMed literature searches were completed using combinations of keywords including "antipsychotic" and "long-acting injectable" or "depot," or generic or brand names of LAIs with "pregnancy." Pregnancy outcomes were compared across studies. RESULTS Twelve relevant case reports of 13 pregnancies were identified. Six cases did not report any negative birth or infant outcomes, including prematurity, infants being born small for gestational age, congenital anomalies, and extrapyramidal symptoms. No cases reported abnormal Apgar scores, infants being born large for gestational age, or negative long-term developmental outcomes after exposure to LAIs during pregnancy. Cesarean section rate was comparable to the general population. Specific adverse outcomes included one infant with multiple congenital anomalies, 3 infants with minor congenital anomalies, and one infant with possible extrapyramidal symptoms. One infant was born prematurely, one infant was born small for gestational age, and 2 infants were born both prematurely and small for gestational age. CONCLUSIONS There is little research specifically examining the use of LAIs in pregnancy, so risks must be extrapolated from studies on oral antipsychotics in pregnancy. While the few published case reports examining LAIs in pregnancy somewhat align with research examining oral antipsychotics, these findings are inconclusive due to the inherently limited nature of case reports. Further investigation into the use of LAIs in pregnancy is warranted.
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Affiliation(s)
- Deirdre L O'Sullivan
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Nancy Byatt
- Department of Psychiatry, UMass Medical School/UMass Memorial Health Care, Shrewsbury, MA
| | - Emily C Dossett
- Departments of Psychiatry and Biobehavioral Sciences and of Obstetrics/Gynecology, Keck School of Medicine at the University of Southern California, Los Angeles, CA
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Puspitasari AJ, Heredia D, Weber E, Betcher HK, Coombes BJ, Brodrick EM, Skinner SM, Tomlinson AL, Salik SS, Allen SV, O'Grady JS, Johnson EK, L'amoureux TM, Moore KM. Perinatal Mood and Anxiety Disorder Management in Multicenter Community Practices: Clinicians' Training, Current Practices and Perceived Strategies to Improve Future Implementation. J Prim Care Community Health 2021; 12:2150132721996888. [PMID: 33618558 PMCID: PMC7905716 DOI: 10.1177/2150132721996888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: This study aimed to explore clinicians’ perspectives on the current practice of perinatal mood and anxiety disorder (PMAD) management and strategies to improve future implementation. Methods: This study had a cross-sectional, descriptive design. A 35-item electronic survey was sent to clinicians (N = 118) who treated perinatal women and practiced at several community clinics at an academic medical center in the United States. Results: Among clinicians who provided care for perinatal women, 34.7% reported never receiving PMAD management training and 66.3% had less than 10 years of experience. Out of 10 patients who reported psychiatric symptoms, 47.8% of clinicians on average reported providing PMAD management to 1 to 3 patients and 40.7% noted that they conducted screening only when patient expresses PMAD symptoms. Suggested future improvements were providing training, developing a referral list, and establishing integrated behavioral health services. Conclusions: Results from this study indicated that while PMAD screening and management was implemented, improvements are warranted to meet established guidelines. Additionally, clinicians endorsed providing PMAD management to a small percentage of perinatal patients. Suggested strategies to increase adoption and implementation of PMAD management should be explored to improve access to behavioral health services for perinatal women.
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Yoon J, Mao Y. Dissecting Molecular Genetic Mechanisms of 1q21.1 CNV in Neuropsychiatric Disorders. Int J Mol Sci 2021; 22:5811. [PMID: 34071723 PMCID: PMC8197994 DOI: 10.3390/ijms22115811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Pathogenic copy number variations (CNVs) contribute to the etiology of neurodevelopmental/neuropsychiatric disorders (NDs). Increased CNV burden has been found to be critically involved in NDs compared with controls in clinical studies. The 1q21.1 CNVs, rare and large chromosomal microduplications and microdeletions, are detected in many patients with NDs. Phenotypes of duplication and deletion appear at the two ends of the spectrum. Microdeletions are predominant in individuals with schizophrenia (SCZ) and microcephaly, whereas microduplications are predominant in individuals with autism spectrum disorder (ASD) and macrocephaly. However, its complexity hinders the discovery of molecular pathways and phenotypic networks. In this review, we summarize the recent genome-wide association studies (GWASs) that have identified candidate genes positively correlated with 1q21.1 CNVs, which are likely to contribute to abnormal phenotypes in carriers. We discuss the clinical data implicated in the 1q21.1 genetic structure that is strongly associated with neurodevelopmental dysfunctions like cognitive impairment and reduced synaptic plasticity. We further present variations reported in the phenotypic severity, genomic penetrance and inheritance.
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Affiliation(s)
| | - Yingwei Mao
- Department of Biology, Eberly College of Science, Pennsylvania State University, University Park, PA 16802, USA;
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Abstract
PURPOSE OF REVIEW A diagnosis of schizophrenia has significant implications for women of childbearing age, pregnant or considering a pregnancy, ranging from sexual health, psychopharmacological treatment, to the occurrence of negative pregnancy and foetal outcomes. We provide a short narrative review of recent papers focusing on these issues. RECENT FINDINGS Although pregnancy rates have been increasing in women with a diagnosis of schizophrenia, they also tend to have altogether fewer pregnancies and fewer live births than women without this diagnosis, and also higher rates of induced abortions.Use of antipsychotics in pregnancy has also increased, and evidence suggests lack of significant contraindications for their use in this period. However, drug levels monitoring may be recommended across the three trimesters, as levels may change in relation to pregnancy-related physiology.Monitoring of physical health is an increasingly crucial issue, given higher risk of gestational diabetes, negative obstetric and infant outcomes in these women. SUMMARY There is an urgent need to generate valid and reproducible research that could help implement appropriate treatment protocols and relapse-prevention approaches, and interventions based on strong pharmaceutical targets for the benefit of pregnant women with a diagnosis of schizophrenia, their families and their children.
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Reduced Motivation in Perinatal Fluoxetine-Treated Mice: A Hypodopaminergic Phenotype. J Neurosci 2021; 41:2723-2732. [PMID: 33536200 DOI: 10.1523/jneurosci.2608-20.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Early life is a sensitive period, in which enhanced neural plasticity allows the developing brain to adapt to its environment. This plasticity can also be a risk factor in which maladaptive development can lead to long-lasting behavioral deficits. Here, we test how early-life exposure to the selective-serotonin-reuptake-inhibitor (SSRI), fluoxetine, affects motivation, and dopaminergic signaling in adulthood. We show for the first time that mice exposed to fluoxetine in the early postnatal period exhibit a reduction in effort-related motivation. These mice also show blunted responses to amphetamine and reduced dopaminergic activation in a sucrose reward task. Interestingly, we find that the reduction in motivation can be rescued in the adult by administering bupropion, a dopamine-norepinephrine reuptake inhibitor used as an antidepressant and a smoke cessation aid but not by fluoxetine. Taken together, our studies highlight the effects of early postnatal exposure of fluoxetine on motivation and demonstrate the involvement of the dopaminergic system in this process.SIGNIFICANCE STATEMENT The developmental period is characterized by enhanced plasticity. During this period, environmental factors have the potential to lead to enduring behavioral changes. Here, we show that exposure to the SSRI fluoxetine during a restricted period in early life leads to a reduction in adult motivation. We further show that this reduction is associated with decreased dopaminergic responsivity. Finally, we show that motivational deficits induced by early-life fluoxetine exposure can be rescued by adult administration of bupropion but not by fluoxetine.
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