A European League Against Rheumatism (EULAR) task force was established to define points to consider on use of antirheumatic drugs before pregnancy, and during pregnancy and lactation. Based on a systematic literature review and pregnancy exposure data from several registries, statements on the compatibility of antirheumatic drugs during pregnancy and lactation were developed. The level of agreement among experts in regard to statements and propositions of use in clinical practice was established by Delphi voting. The task force defined 4 overarching principles and 11 points to consider for use of antirheumatic drugs during pregnancy and lactation. Compatibility with pregnancy and lactation was found for antimalarials, sulfasalazine, azathioprine, ciclosporin, tacrolimus, colchicine, intravenous immunoglobulin and glucocorticoids. Methotrexate, mycophenolate mofetil and cyclophosphamide require discontinuation before conception due to proven teratogenicity. Insufficient documentation in regard to fetal safety implies the discontinuation of leflunomide, tofacitinib as well as abatacept, rituximab, belimumab, tocilizumab, ustekinumab and anakinra before a planned pregnancy. Among biologics tumour necrosis factor inhibitors are best studied and appear reasonably safe with first and second trimester use. Restrictions in use apply for the few proven teratogenic drugs and the large proportion of medications for which insufficient safety data for the fetus/child are available. Effective drug treatment of active inflammatory rheumatic disease is possible with reasonable safety for the fetus/child during pregnancy and lactation. The dissemination of the data to health professionals and patients as well as their implementation into clinical practice may help to improve the management of pregnant and lactating patients with rheumatic disease.

https://ard.bmj.com/content/annrheumdis/75/5/795.full.pdf

The EULAR Points to Consider for Use of Antirheumatic Drugs Before Pregnancy, and During Pregnancy and Lactation

Objectives. This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societi...

/pdf/world-federation-of-societies-of-biological-psychiatry-wfsbp-3lyactzylc.pdf

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the Acute and Continuation Treatment of Unipolar Depressive Disorders

Background: The risk of relapse of depression or the diagnosis of some other psychiatric disorders during pregnancy necessitates the use of antidepressants despite possible adverse effects. Whether such use increases the risk of spontaneous abortion is still being debated. We evaluated the risk of spontaneous abortion in relation to the use of antidepressants during pregnancy. Methods: Using a nested case–control study design, we obtained data from the Quebec Pregnancy Registry for 5124 women who had a clinically detected spontaneous abortion. For each case, we randomly selected 10 controls from the remaining women in the registry who were matched by the case’s index date (date of spontaneous abortion) and gestational age at the time of spontaneous abortion. Use of antidepressants was defined by filled prescriptions and was compared with nonuse. We also studied the classes, types and doses of antidepressants. Results: A total of 284 (5.5%) of the women who had a spontaneous abortion had at least one prescription for an antidepressant filled during the pregnancy, as compared with 1401 (2.7%) of the matched controls (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.83–2.38). After adjustment for potential confounders, we found that the use of antidepressants during pregnancy was associated with an increased risk of spontaneous abortion (OR 1.68, 95%CI 1.38–2.06). Stratified analyses showed that use of selective serotonin reuptake inhibitors alone (OR 1.61, 95% CI 1.28–2.04), serotonin–norepinephrine reuptake inhibitors alone (OR 2.11, 95% CI 1.34–3.30) and combined use of antide-pressants from different classes (OR 3.51, 95% CI 2.20–5.61) were associated with an increased risk of spontaneous abortion. When we looked at antidepressant use by type versus no use, paroxetine use alone (OR 1.75, 95% CI 1.31–2.34) and venlafaxine use alone (OR 2.11, 95% CI 1.34–3.30) were associated with an increased risk of spontaneous abortion. Interpretation: The use of antidepressants, especially paroxetine, venlafaxine or the combined use of different classes of antidepressants, during pregnancy was associated with an increased risk of spontaneous abortion.

/pdf/use-of-antidepressants-during-pregnancy-and-the-risk-of-4fruqw3x52.pdf

Use of antidepressants during pregnancy and the risk of spontaneous abortion

CONTEXT\nDespite the frequency of depression in women of childbearing age, information to guide patients and physicians through a consideration of treatment during pregnancy is limited.\n\n\nOBJECTIVE\nTo identify risk factors associated with treatment of major depression during pregnancy to help physicians develop treatment plans that optimize clinical care.\n\n\nDATA SOURCES\nReports of prospective controlled trials in English were identified from MEDLINE and Health STAR using the search terms antidepressant during pregnancy and depression during pregnancy, by manually searching bibliographies of review articles, and through discussions with investigators for 1989-1999.\n\n\nSTUDY SELECTION\nWe selected studies in which maternal and infant health outcomes associated with antidepressant exposure were compared with those of non-teratogen-exposed controls. Four studies published since 1993 were identified and included in the analysis.\n\n\nDATA EXTRACTION\nWe abstracted information about identification of subjects, comparison groups, pregnancy, and birth outcomes. We organized the data along 5 domains of reproductive toxicity: intrauterine fetal death, morphologic teratogenicity, growth impairment, behavioral teratogenicity, and neonatal toxicity.\n\n\nDATA SYNTHESIS\nData were available for tricyclic antidepressants (collectively), fluoxetine, and newer selective serotonin reuptake inhibitors (collectively). Exposure to these agents did not increase risk for intrauterine death or major birth defects. Decreased birth weights of infants exposed to fluoxetine in the third trimester were identified in 1 study. The development of children whose mothers took tricyclics or fluoxetine during gestation did not differ from that of controls. Direct drug effects and withdrawal syndromes occurred in some neonates whose mothers were treated with antidepressants near term.\n\n\nCONCLUSIONS\nAlthough few in number, new information from prospective studies provides a welcome change from decision making based on nonprospective data. Monitoring and interventions for patients with identified risks (eg, poor weight gain) are recommended.

Pharmacologic treatment of depression during pregnancy

A population group consisting of 800 households of women who recently had been pregnant was surveyed to determine the level of consumption of a variety of beverages. Three fourths of the subjects were Mormon. Of a subgroup of 16 women identified as having an estimated daily intake of caffeine of 600 mg or greater, 13 had experienced a reproductive loss in the form of spontaneous abortion (eight) or stillbirth (five), two had given birth to premature infants, and only one had had an uncomplicated delivery. An inordinately high rate or reproductive loss also was noted in 13 households where the man's estimated daily intake of caffeine was greater than 600 mg. A cause-and-effect relationship cannot be determined by this type of retrospective study, but physicians should keep in mind the possibility that an excessive intake of caffeine may be a factor in otherwise unexplainable spontaneous abortion or perinatal mortality.

Caffeine and pregnancy. A retrospective survey.

We thank Einarson [1][1] for her commentary on our study on the risk of spontaneous abortion associated with antidepressant use. [2][2] Although it is true that we cannot assess causality based on one observational study owing to the inherent potential biases, repetition of findings, which is a

/pdf/antidepressant-use-during-pregnancy-and-miscarriage-3rxjgh1w9h.pdf

Antidepressant use (during pregnancy) and miscarriage.

Background: The association between the use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy and the risk of spontaneous abortion remains unclear because of inconsistent research results and the lack of evidence for an effect due to specific types or dosages of nonaspirin NSAIDs. We aimed to quantify the association between having a spontaneous abortion and types and dosages of nonaspirin NSAIDs in a cohort of pregnant women. Methods: Using a nested case–control design, we obtained data from the Quebec Pregnancy Registry for 4705 women who had a spontaneous abortion. For each instance, we randomly selected 10 controls from the remaining women in the registry who were matched by index date (date of the spontaneous abortion) and gestational age. Use of nonaspirin NSAIDs (identified by filled prescriptions) and nonuse were compared. We also looked for associations between different types and dosages of nonaspirin NSAIDs and having a spontaneous abortion. Analyses of associations and adjustment for confounding were done using conditional logistic regression. Results: We identified 4705 cases of spontaneous abortion (352 exposed [7.5%]); 47 050 controls (1213 exposed [2.6%]). Adjusting for potential confounders, the use of nonaspirin NSAIDs during pregnancy was significantly associated with the risk of spontaneous abortion (odds ratio [OR] 2.43, 95% confidence interval [CI] 2.12–2.79). Specifically, use of diclofenac (OR 3.09, 95% CI 1.96–4.87), naproxen (OR 2.64, 95% CI 2.13–3.28), celecoxib (OR 2.21, 95% CI 1.42–3.45), ibuprofen (OR 2.19, 95% CI 1.61–2.96) and rofecoxib (OR 1.83, 95% CI 1.24–2.70) alone, and combinations thereof (OR 2.64, 95% CI 1.59–4.39), were all associated with increased risk of spontaneous abortion. No dose–response effect was seen. Interpretation: Gestational exposure to any type or dosage of nonaspirin NSAIDs may increase the risk of spontaneous abortion. These drugs should be used with caution during pregnancy

/pdf/use-of-nonaspirin-nonsteroidal-anti-inflammatory-drugs-4oytrdw415.pdf

Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion

BACKGROUND Although the relationship between antidepressant use during pregnancy and its adverse effects has been widely investigated, very few studies have evaluated the impact of antidepressant use during pregnancy on the risk of spontaneous abortion. We present an overview of the evidence relating to the association between antidepressant use during gestation and the risk of spontaneous abortion. METHODS We systematically searched PubMed and the reference lists of all relevant articles, including reviews, published in English or French from 1975 through 2009 for studies that examined the association between adverse pregnancy outcomes and gestational exposure to antidepressants with data on spontaneous abortions. Only etiologic studies were considered. RESULTS Fifteen studies met inclusion criteria. The majority of these were prospective cohort studies on tricyclics antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) use during pregnancy. Overall, in unadjusted analyses, fluoxetine (OR = 2.0; 95% CI = 1.4 - 3.0) and bupropion (OR = 4.1; 95% CI = 1.5 - 11.1) were significantly associated with the risk of spontaneous abortion. However, in adjusted analyses, only paroxetine (OR = 1.7; 95% CI = 1.3 - 2.3) and venlafaxine (OR = 2.1; 95% CI = 1.3 - 3.3) were significantly associated with the risk of spontaneous abortion. CONCLUSIONS This review suggests that gestational exposure to antidepressants, especially paroxetine and venlafaxine, can lead to spontaneous abortion.

https://www.doyoubuzz.com/var/f/Bo/Mu/BoMu7VQs8kZ0Oqgpf9WmF1XYG2ARayUzS5xtPivE_C6jewLJNb.pdf

Gestational Exposure to Antidepressants and the Risk of Spontaneous Abortion: A Review

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

Perrine Broy

Author Tools

Chat about Author

Papers

Use of antidepressants during pregnancy and the risk of spontaneous abortion

Antidepressant use (during pregnancy) and miscarriage.

Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion

Gestational Exposure to Antidepressants and the Risk of Spontaneous Abortion: A Review