Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study

BMJ 2017;358:j3668

This population based cohort study aims to investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.  905 383 liveborn singletons born during 1998-2012 in Denmark were followed from birth until July 2014, death, emigration, or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×106 person years at risk. The study concludes that in utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. The findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.

Click here to read the full text paper.

Advertisements

Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study

BMJ 2017;358:j3326

This observational cohort study aims to assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.  The study concludes that during pregnancy, the use of psychotropic medications in addition to prescription opioids is common, despite a lack of safety data. The current findings suggest that these drugs could further increase the risk and severity of neonatal drug withdrawal.

Click here to access the full text paper.

Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study

BMJ 2017;357:j2350

This population based cohort study aims to assess the potential association between prenatal use of antidepressants and the risk of attention-deficit/hyperactivity disorder (ADHD) in offspring.  The findings suggest that the association between prenatal use of antidepressants and risk of ADHD in offspring can be partially explained by confounding by indication of antidepressants. If there is a causal association, the size of the effect is probably smaller than that reported previously.

Click here to read the full text paper.

Modelling foetal exposure to maternal smoking using hepatoblasts from pluripotent stem cells

Lucendo-Villarin, B., Filis, P., Swortwood, M.J. et al. Archives of Toxicology (2017). doi:10.1007/s00204-017-1983-0

This study looks at the effect of cigarette smoking on the developing liver cells of foetuses whose mothers smoke with a new approach using embryonic stem cells.  The study showed that a chemical cocktail – similar to that found in cigarettes – harmed foetal liver health more than individual components.

Click here to view the full text article.

 

Use of electronic cigarettes in pregnancy: A guide for midwives and other healthcare professionals

Smoke Free Action, June 2016

This short briefing has been produced by the Smoking in Pregnancy Challenge Group and is intended to provide a summary of the evidence on electronic cigarettes, with suggested responses to some frequently asked questions about their use during pregnancy.

Click here to view the briefing.

Financial incentives for smoking cessation in pregnancy: randomised controlled trial

BMJ, 27 January 2015

The objective of the research was to assess the efficacy of a financial incentive added to routine specialist pregnancy stop smoking services versus routine care to help pregnant smokers quit.

612 self reported pregnant smokers in NHS Greater Glasgow and Clyde who were English speaking participated in the study.  The control group received routine care, which was the offer of a face to face appointment to discuss smoking and cessation and, for those who attended and set a quit date, the offer of free nicotine replacement therapy for 10 weeks provided by pharmacy services, and four, weekly support phone calls. The intervention group received routine care plus the offer of up to £400 of shopping vouchers: £50 for attending a face to face appointment and setting a quit date; then another £50 if at four weeks’ post-quit date exhaled carbon monoxide confirmed quitting; a further £100 was provided for continued validated abstinence of exhaled carbon monoxide after 12 weeks; a final £200 voucher was provided for validated abstinence of exhaled carbon monoxide at 34-38 weeks’ gestation.

Recruitment was extended from 12 to 15 months to achieve the target sample size. Follow-up continued until September 2013. Of the 306 women randomised, three controls opted out soon after enrolment; these women did not want their data to be used, leaving 306 intervention and 303 control group participants in the intention to treat analysis. No harms of financial incentives were documented. Significantly more smokers in the incentives group than control group stopped smoking: 69 (22.5%) versus 26 (8.6%). The relative risk of not smoking at the end of pregnancy was 2.63 (95% confidence interval 1.73 to 4.01) P<0.001. The absolute risk difference was 14.0% (95% confidence interval 8.2% to 19.7%). The number needed to treat (where financial incentives need to be offered to achieve one extra quitter in late pregnancy) was 7.2 (95% confidence interval 5.1 to 12.2). The mean birth weight was 3140 g (SD 600 g) in the incentives group and 3120 (SD 590) g in the control group (P=0.67).

This phase II randomised controlled trial provides substantial evidence for the efficacy of incentives for smoking cessation in pregnancy; as this was only a single centre trial, incentives should now be tested in different types of pregnancy cessation services and in different parts of the United Kingdom.

Click here to read the full text paper.