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Lecture 29

BIOCHEM 4M03 Lecture Notes - Lecture 29: Gestational Diabetes, Major Depressive Episode, Postpartum Depression


Department
Biochemistry
Course Code
BIOCHEM 4M03
Professor
Deborah Sloboda
Lecture
29

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Biochem 4M03 – Lecture 29 - Dr. Holloway’s Lecture
Use of antidepressants during pregnancy: Is there a risk of adverse metabolic outcomes
for the mother and baby?
Mental Illness: Overview
- Mental illness results in more disability in developed countries than any other group of
illnesses, including cancer and heart disease
- The most common mental illnesses in adults are anxiety and mood disorders
Depression is a widespread problem
-This data is from 2006 but it hasn’t decreased
-Still an increasing problem
Mental illness: Canada
-20% of Canadians will experience a mental illness in their lifetime
-4.7% of Canadians aged 15 and older met the criteria for a major depressive episode in
the past 12 months
-Approximately 8% of adults will experience major depression at some time in their lives
Lifetime occurrence of major depressive disorder is sex dependent
Depression and Pregnancy
-The prevalence of depression in women of childbearing age (above right graph)
oWomen are twice as likely as men to experience major depressive disorder
(21.3% vs. 12.7%)
-Pregnancy appears to be a window of vulnerability for the exacerbation of existing
depression and the development of new disease
-The prevalence of antenatal and postpartum depression in North American women is
generally estimated to be 10-15%
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-Higher rates reported in:
oWomen who are unmarried (widowed, single or divorced)
oWomen with low income
oAdolescents (8-47%)
oAboriginal women (38%)
-Prevalence (postpartum depression)
oDomestic violence during pregnancy increases risk of PPD
oMothers of preterm and/or very LBW babies are at increased risk of PPD
Treatments for Perinatal Depression
-Support groups/cognitive behavioural therapy (CBT)
-Generally for mild depression – CBT
oFor severe cases, this doesn’t seem to work on its own
-Non-pharmacological, psychosocial or psychological interventions – like getting sun
-Medication
Antidepressant use
-From 2005-2008 antidepressants were the 3rd most commonly prescribed drugs in the
United States
-Overall prevalence of antidepressant use in the United States increased from 6.5% in
1999-2000 to 10.4% in 2009-1010
-In Ontario, the percentage of adults who reported using antidepressants rose from 4% in
1999 to 7% in 2011 (Population estimate = 654 4000 Ontarians)
Antidepressants use in pregnancy
-Commonly prescribed cause not many congenital malformities to fetus
-Antidepressant use in pregnant women increased from 2% in 1996 to over 7% in 2008
-Selective serotonin reuptake inhibitors (SSRIs) are most commonly prescribed during
pregnancy
-Antidepressant use is associated with adverse metabolic outcomes
oAssociated with an increased risk of: weight gain, type 2 diabetes, hyperlipidemia
Antidepressant ranking and effect on body weight (ranked from most weight gain to
weight loss)
-3 are associated with weight gain in non-pregnant adults
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oParoxetine
oCitalopram
oEscitalopram
-3 of 12 antidepressants associated with weight gain are SSRIs
Increased risk of type 2 diabetes with SSRI exposure
-SSRI use is associated with an increased risk of new onset type 2 diabetes
-Children and adolescents (OR = 1.37; 95% Cl 1.10-1.71)
-Adults (SSRI use greater than 24 months) (incidence rate ratio = 2.06; 95% Cl=1.20-
3.52)
What about in pregnancy?
-Non-systematic reviews suggest higher maternal weight gain and an increased risk of
gestational diabetes mellitus with psychiatric medication use during pregnancy
-Systematic review of maternal metabolic outcomes associated with psychiatric
medication use
oFound no evidence of an increased risk of gestational weight gain, gestational
diabetes or postpartum weight retention in women with psychiatric illness who
took psychiatric medications compared to non-medicated women with psychiatric
illness
oLimitations: N=2 studies with a control group of non-medicated women with
psychiatric illness
One study had only N=3 in the control (non-medicated, depressed) group
What about the baby?
-SSRI exposure has been reported to be associated with an increased risk of:
oPreterm Birth: 1.69 [95% Cl 152-1.88]
oLow Birth Weight: 1.44 [95% Cl 1.21-1.70]
oIUGR: 1.45 [95% Cl 1.05-2.02]
The Barker Hypothesis
-Adverse environments in fetal life and early childhood establishes an increased risk of
disease in adult life
Antenatal exposure to depression: postnatal metabolic deficits
-Adverse intrauterine environment  metabolic disorders in later life
Drug or depression
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