“PROZAC BABY” – 25 YEARS OF MOTHERISK RESEARCH INTO SSRI’s AND ALCOHOL IN PREGNANCY
Main Article Content
Keywords
Depression, pregnancy, SSRIs, fluoxetine, fetal alcohol spectrum disorder, misinformation
Abstract
A summary of the debate regarding the safety of antidepressants in pregnancy is presented through the story of Prozac Baby. This is a diary of a fetus who finds out ( to his horror ) that his mother intends to abort him due to misinformation she has received. The novel, Prozac Baby , was written by Dr . Gideon Koren, based on his experience at Motherisk. An update on the risks of alcohol in pregnancy is also provided.
References
1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006;38(2):90- 96.
2. Koren G, Bologa M, Long D, et al. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol 1989;160(5 Pt 1):1190- 1194.
3. Loebstein R, Addis A, Ho E, et al. Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study. Antimicrob Agents Chemother. 1998 [cited 2 014 Jul 12];42(6):1336- 1339. Available from: http://aac.asm.org/cgi/pmidlookup?view=long& pmid=9624471
4. Bar-Oz B, Levichek Z, Moretti ME, et al. Pregnancy outcome following rubella vaccination: a prospective controlled study. Am J Med Genet A 2004;130A(1):52- 54.
5. Trichopoulos D, Zavitsanos X, Koutis C, et al. The victims of Chernobyl in Greece: induced abortions after the accident [letter]. BMJ. 1987 [cited 2014 Jul 8];295(6606):1000. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 1248180
6. Bentur Y, Horlatsch N, Koren G. Exposure to ionizing radiation during pregnancy: perception of teratogenic risk and outcome. Teratology 1991;43(2):109- 112.
7. Cohen- Kerem R, Nulman I, Abramow -Newerly M, et al. Diagnostic radiation in pregnancy: perception versus true risks. J Obstet Gynaecol Can 2006 Jan;28(1):43- 48.
8. Koren G, Pastuszak A. Prevention of unnecessary pregnancy terminations by counselling women on drug, chemical, and radiation exposure during the first trimester. Teratology 1990;41(6):657- 661.
9. Shepard TH, Lemire RJ, ed. Catalog of Teratogenic Agents, 12th ed. Baltimore (MD): Johns Hopkins University Press; 2007.
10. Nul man I, Koren G. The safety of fluoxetine during pregnancy and lactation. Teratology 1996;53(5):304- 308.
11. Nulman I, Rovet J, Stewart DE, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002 [cited 2014 Jul 12];159(11):1889- 1895. Available from: http://ajp.psychiatryonline.org/article.aspx?articl eid=175855 12. Einarson A, Selby P, Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 2001 [cited 2014 Jul 12];26(1):44- 48. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 1408034/pdf/jpn00089- 0046.pdf
13. Myles N, Newall H, Ward H, et al. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust NZJ Psychiatry 2013;47(11):1002- 1012.
14. Grigoriadis S, Vonder Porten EH, Mamisashvili L, et al. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence. J Clin Psychiatry 2013;74(4):e293- e308.
15. Einarson A, Pistelli A, DeSantis M, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry 2008 [cited 2014 J ul 12];165(5):749- 752. Available from: http://ajp.psychiatryonline.org/article.aspx?articl eid=99899
16. Jimenez -Solem E, Andersen JT, Petersen M, et al. Exposure to selective serotonin reuptake inhibitors and the risk of congenital malformations: a nationwide cohort study. BMJ Open 2 012 [cited 2014 Jul 13];2(3). pii: e001148. Available from: http://bmjopen.bmj.com/content/2/3/e001148.long
17. Oberlander TF, Misri S, Fitzgerals CE, et al. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry 2004;65(2):230- 237.
18. Pogliani L, Schneider L, Dilillo D, et al. Paroxetine and neonatal withdrawal syndrome. BMJ Case Rep 2010 [cited 2014 Jul 13]. pii: bcr1220092528. Available from: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC 3047551
19. Knoppert DC, Nimkar R, Principi T, et al. Paroxetine toxicity in a newborn after in utero exposure: clinical symptoms correlate with serum levels. Ther Drug Monit 2006;28(1):5- 7.
20. Koren G, Matsui D, Einarson A, et al. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? CMAJ 2005 [cited 2014 Jul 13];172(11):1457- 1459. Available from: http://www.cmaj.ca/conten t/172/11/1457.long
21. Chambers CD, Hernandez -Diaz S, Van Marter LJ, et al. Selective serotonin -reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. NEJM 2006 [cited 2014 Jul 13];354(6):579- 587. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa0 52744
22. Nulman I, Rovet J, Stewart DE, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. NEJM 1997 [cited 2014 Jul 13];336(4):258- 262. Available from: http://www.nejm.org/doi/full/10.1056/NEJM199 701233360404
23. Nulman I, Koren G, Rovet J, et al. Neurodevelopment of children following prenatal exposure to venlafaxine, selective serotonin reuptake inhibitors, or untreated maternal depression. Am J Psychiatry 2012 [cited 2014 Jul 13];169(11):1165- 1174. Available from: http://ajp.psychiatryonline.org/article.aspx?articl eid=1389519
24. Goodman SH, Rouse MH, Connell AM, et al. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 2011;14(1):1 -27.
25. Fetal Alcohol Spectrum Disorder (FASD) [Internet]. Ottawa (ON): Public Health Agency of Canada; 2014 Apr 29 [cited 2014 Jul 20]. Available from: http://ww w.phac -aspc.gc.ca/hp - ps/dca -dea/prog -ini/fasd -etcaf/index -eng.php
26. Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta 2006;366(1- 2):101- 111.
27. Gray T, Huestis M. Bioanalytical procedures for monitoring in utero drug exposure. Anal Bioanal Chem 2007 [cited 2014 Jul 20];388(7):1455- 1465. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2714867
28. Gray TR, Shakleya DM, Huestis MA. A liquid chromatography tand em mass spectrometry method for the simultaneous quantification of 20 drugs of abuse and metabolites in human meconium. Anal Bioanal Chem 2009 [cited 2014 Jul 20]; 393(8):1977 –1990. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3165042
29. Bearer CF, Lee S, Salvator AE, et al. Ethyl linoleate in meconium: a biomarker for prenatal ethanol exposure. Alcohol Clin Exp Res 1999;23(3):487- 493. 30. Klein J, Karaskov T, Koren G. Fatty acid ethyl esters: a novel biologic marker for heavy in utero ethanol exposure: a case report. Ther Drug Monit 1999;21(6):644- 646.
31. Bearer CF, Jacobson JL, Jacobson SW, et al. Validation of a new biomarker of fetal exposure to alcohol. J Pediatr 2003;143(4):463- 469.
32. Chan D, Bar -Oz B, Pellerin B, et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit 2003;25(3):271- 278.
33. Chan D, Knie B, Boskovic R, et al. Placental handling of fatty acid ethyl esters: perfusion and subcellular studies. J Pharmacol Exp Ther 2004 [cited 2014 Jul 20];310(1):75- 82. Available from: http://jpet.aspetjournals.org/content/31 0/1/75.long
34. Statistics by country for congenital hypothyroidism [Internet]. [place unknown]: Health Grades Inc.; c 2014 [updated 2014 Jun 17; cited 2014 Jul 20]. Available from: http://www.rightdiagnosis.com/c/congenital_hyp othyroidism/stats -country.htm
35. Hanley WB. Newborn screening in Canada – Are we out of step? Paediatr Child Health 2005;10(4):203- 207.
2. Koren G, Bologa M, Long D, et al. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol 1989;160(5 Pt 1):1190- 1194.
3. Loebstein R, Addis A, Ho E, et al. Pregnancy outcome following gestational exposure to fluoroquinolones: a multicenter prospective controlled study. Antimicrob Agents Chemother. 1998 [cited 2 014 Jul 12];42(6):1336- 1339. Available from: http://aac.asm.org/cgi/pmidlookup?view=long& pmid=9624471
4. Bar-Oz B, Levichek Z, Moretti ME, et al. Pregnancy outcome following rubella vaccination: a prospective controlled study. Am J Med Genet A 2004;130A(1):52- 54.
5. Trichopoulos D, Zavitsanos X, Koutis C, et al. The victims of Chernobyl in Greece: induced abortions after the accident [letter]. BMJ. 1987 [cited 2014 Jul 8];295(6606):1000. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 1248180
6. Bentur Y, Horlatsch N, Koren G. Exposure to ionizing radiation during pregnancy: perception of teratogenic risk and outcome. Teratology 1991;43(2):109- 112.
7. Cohen- Kerem R, Nulman I, Abramow -Newerly M, et al. Diagnostic radiation in pregnancy: perception versus true risks. J Obstet Gynaecol Can 2006 Jan;28(1):43- 48.
8. Koren G, Pastuszak A. Prevention of unnecessary pregnancy terminations by counselling women on drug, chemical, and radiation exposure during the first trimester. Teratology 1990;41(6):657- 661.
9. Shepard TH, Lemire RJ, ed. Catalog of Teratogenic Agents, 12th ed. Baltimore (MD): Johns Hopkins University Press; 2007.
10. Nul man I, Koren G. The safety of fluoxetine during pregnancy and lactation. Teratology 1996;53(5):304- 308.
11. Nulman I, Rovet J, Stewart DE, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry 2002 [cited 2014 Jul 12];159(11):1889- 1895. Available from: http://ajp.psychiatryonline.org/article.aspx?articl eid=175855 12. Einarson A, Selby P, Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 2001 [cited 2014 Jul 12];26(1):44- 48. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 1408034/pdf/jpn00089- 0046.pdf
13. Myles N, Newall H, Ward H, et al. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust NZJ Psychiatry 2013;47(11):1002- 1012.
14. Grigoriadis S, Vonder Porten EH, Mamisashvili L, et al. Antidepressant exposure during pregnancy and congenital malformations: is there an association? A systematic review and meta-analysis of the best evidence. J Clin Psychiatry 2013;74(4):e293- e308.
15. Einarson A, Pistelli A, DeSantis M, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry 2008 [cited 2014 J ul 12];165(5):749- 752. Available from: http://ajp.psychiatryonline.org/article.aspx?articl eid=99899
16. Jimenez -Solem E, Andersen JT, Petersen M, et al. Exposure to selective serotonin reuptake inhibitors and the risk of congenital malformations: a nationwide cohort study. BMJ Open 2 012 [cited 2014 Jul 13];2(3). pii: e001148. Available from: http://bmjopen.bmj.com/content/2/3/e001148.long
17. Oberlander TF, Misri S, Fitzgerals CE, et al. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry 2004;65(2):230- 237.
18. Pogliani L, Schneider L, Dilillo D, et al. Paroxetine and neonatal withdrawal syndrome. BMJ Case Rep 2010 [cited 2014 Jul 13]. pii: bcr1220092528. Available from: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC 3047551
19. Knoppert DC, Nimkar R, Principi T, et al. Paroxetine toxicity in a newborn after in utero exposure: clinical symptoms correlate with serum levels. Ther Drug Monit 2006;28(1):5- 7.
20. Koren G, Matsui D, Einarson A, et al. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? CMAJ 2005 [cited 2014 Jul 13];172(11):1457- 1459. Available from: http://www.cmaj.ca/conten t/172/11/1457.long
21. Chambers CD, Hernandez -Diaz S, Van Marter LJ, et al. Selective serotonin -reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. NEJM 2006 [cited 2014 Jul 13];354(6):579- 587. Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa0 52744
22. Nulman I, Rovet J, Stewart DE, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. NEJM 1997 [cited 2014 Jul 13];336(4):258- 262. Available from: http://www.nejm.org/doi/full/10.1056/NEJM199 701233360404
23. Nulman I, Koren G, Rovet J, et al. Neurodevelopment of children following prenatal exposure to venlafaxine, selective serotonin reuptake inhibitors, or untreated maternal depression. Am J Psychiatry 2012 [cited 2014 Jul 13];169(11):1165- 1174. Available from: http://ajp.psychiatryonline.org/article.aspx?articl eid=1389519
24. Goodman SH, Rouse MH, Connell AM, et al. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 2011;14(1):1 -27.
25. Fetal Alcohol Spectrum Disorder (FASD) [Internet]. Ottawa (ON): Public Health Agency of Canada; 2014 Apr 29 [cited 2014 Jul 20]. Available from: http://ww w.phac -aspc.gc.ca/hp - ps/dca -dea/prog -ini/fasd -etcaf/index -eng.php
26. Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta 2006;366(1- 2):101- 111.
27. Gray T, Huestis M. Bioanalytical procedures for monitoring in utero drug exposure. Anal Bioanal Chem 2007 [cited 2014 Jul 20];388(7):1455- 1465. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2714867
28. Gray TR, Shakleya DM, Huestis MA. A liquid chromatography tand em mass spectrometry method for the simultaneous quantification of 20 drugs of abuse and metabolites in human meconium. Anal Bioanal Chem 2009 [cited 2014 Jul 20]; 393(8):1977 –1990. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 3165042
29. Bearer CF, Lee S, Salvator AE, et al. Ethyl linoleate in meconium: a biomarker for prenatal ethanol exposure. Alcohol Clin Exp Res 1999;23(3):487- 493. 30. Klein J, Karaskov T, Koren G. Fatty acid ethyl esters: a novel biologic marker for heavy in utero ethanol exposure: a case report. Ther Drug Monit 1999;21(6):644- 646.
31. Bearer CF, Jacobson JL, Jacobson SW, et al. Validation of a new biomarker of fetal exposure to alcohol. J Pediatr 2003;143(4):463- 469.
32. Chan D, Bar -Oz B, Pellerin B, et al. Population baseline of meconium fatty acid ethyl esters among infants of nondrinking women in Jerusalem and Toronto. Ther Drug Monit 2003;25(3):271- 278.
33. Chan D, Knie B, Boskovic R, et al. Placental handling of fatty acid ethyl esters: perfusion and subcellular studies. J Pharmacol Exp Ther 2004 [cited 2014 Jul 20];310(1):75- 82. Available from: http://jpet.aspetjournals.org/content/31 0/1/75.long
34. Statistics by country for congenital hypothyroidism [Internet]. [place unknown]: Health Grades Inc.; c 2014 [updated 2014 Jun 17; cited 2014 Jul 20]. Available from: http://www.rightdiagnosis.com/c/congenital_hyp othyroidism/stats -country.htm
35. Hanley WB. Newborn screening in Canada – Are we out of step? Paediatr Child Health 2005;10(4):203- 207.