Martin St-André

Effects of Selective Serotonin Reuptake Inhibitors and Venlafaxine During Pregnancy in Term and Preterm Neonates

OBJECTIVES. Our goals were to (a) describe neonatal behavioral signs in a group of newborns exposed in utero to selective serotonin reuptake inhibitors or venlafaxine at the time of delivery, (b) compare the rate of neonatal behavioral signs, prematurity, and admission to specialized neonatal care between a group of exposed and unexposed newborns, and (c) compare the effects in exposed preterm and term newborns. PATIENTS AND METHODS. This was a retrospective cohort study including mothers taking selective serotonin reuptake inhibitors or venlafaxine during the third trimester and mothers who were not taking any antidepressants, psychotropic agents, or benzodiazepines at the time of delivery of their newborns. Neonatal behavioral signs included central nervous, respiratory, and digestive systems, as well as hypoglycemia and the need for phototherapy. RESULTS. Seventy-six mothers taking antidepressants and 90 untreated mothers and their newborns were analyzed. Smoking, alcohol intake, and substance abuse were more frequent among treated mothers. In infants in the exposed group, signs involving the central nervous and the respiratory systems were often observed (63.2% and 40.8%, respectively). These signs appeared during the first day of life, with a median duration of 3 days for exposed newborns. The signs resolved in 75% of cases within 3 to 5 days for term and premature newborns, respectively. All exposed premature newborns presented behavioral manifestations compared with 69.1% of term exposed newborns. Median length of stay was almost 4 times longer for exposed premature newborns than for those who were unexposed (14.5 vs 3.7 days). CONCLUSIONS. Neonatal behavioral signs were frequently found in exposed newborns, but symptoms were transient and self-limited. Premature infants could be more susceptible to the effects of selective serotonin reuptake inhibitors and venlafaxine.

Duration of antidepressant use during pregnancy and risk of major congenital malformations

BACKGROUND Antidepressant use during the gestational period is a controversial topic. AIMS To determine whether duration of antidepressant use during the first trimester increases the risk of major congenital malformations in offspring of women diagnosed with psychiatric disorders. METHOD A case-control study was performed among women who had been pregnant between January 1998 and December 2002. Data were obtained from a Medication and Pregnancy registry, built by linking three databases from the province of Quebec, and a self-administered questionnaire. Women eligible for this study had to be 15-45 years old at the beginning of pregnancy, have at least one diagnosis of psychiatric disorder before pregnancy, have used antidepressants for > or =30 days in the year prior to pregnancy and have a pregnancy ending with a delivery. Cases were defined as any major congenital malformation diagnosed in the offsprings first year of life. Odds ratios, adjusted for relevant confounders, were estimated using logistic regression. RESULTS Among the 2329 women meeting the inclusion criteria, 189 (8.1%) infants were born with a major congenital malformation. Duration of antidepressant use during the first trimester of pregnancy was not associated with an increased risk of major congenital malformations: 1-30 days v. 0 day, adjusted OR=1.23 (95% CI 0.77-1.98); 31-60 days v. 0 day, adjusted OR=1.03 (95% CI 0.63-1.69); > or =61 days v. 0 day, adjusted OR=0.92 (95% CI 0.50-1.69). CONCLUSIONS These data do not support an association between duration of antidepressant use during the first trimester of pregnancy and major congenital malformations in the offspring of women with psychiatric disorders. These findings should help clinicians decide whether to continue antidepressant therapy during pregnancy.

Whose rights count? Negotiating practice, policy, and legal dilemmas regarding infant-parent contact when infants are in out-of-home care

Abstract This article takes a human rights perspective with a view to articulating the infant’s perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well-being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow-up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infant–parent attachment relationships as well as infant mental health to illuminate the infant’s subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often associated with contact.

ANXIETY AND ATTACHMENT TO THE MOTHER IN PRESCHOOLERS RECEIVING PSYCHIATRIC CARE: THE FATHER–CHILD ACTIVATION RELATIONSHIP AS A PROTECTIVE FACTOR

This 49-family study is the first to explore the father-child relationship in a clinical population of preschoolers (at a tertiary care child psychiatry clinic) and to examine its relation to child anxiety and attachment to the mother. A moderation model of the father-child activation relationship on the relation between attachment to the mother and child anxiety was tested and discussed. Analyses confirmed the expected independence between mother-child attachment and father-child activation as well as the association between mother-child attachment and anxiety. The highest levels of anxiety were found in insecure children, and more specifically, in insecure-ambivalent children and insecure disorganized-controlling children of the caregiving subtype. Hypotheses regarding the relation between anxiety and activation were only partially confirmed. Finally, the activation relationship with the father was shown to have a moderating effect on the relation between attachment to the mother and child anxiety; activation by the father may be considered either a protective or a risk factor. Results for this clinical population of young children are discussed in the light of attachment theory and activation relationship theory. The studys findings have the potential to contribute to the development of preventative, diagnostic, and intervention programs that take both parental figures into account.

Child attachment and sensory regulation in psychiatric clinic-referred preschoolers:

Background: Individuals with sensory regulation disorders present with many difficulties in terms of managing emotions, behavior, and motor control. Children with such difficulties are often referred to psychiatric clinics for assessment of their behavioral and emotional problems. Few studies have investigated the role of environmental factors on sensory dysfunctions, and none have specifically studied its association with child attachment in a clinical sample. Objective: In this cross-sectional study, we examined the association between sensory regulation and child attachment among preschoolers referred to a psychiatric clinic. Method: A sample of 60 preschoolers and their mothers were recruited through a child psychiatric clinic. Child attachment was assessed with the gold standard separation–reunion procedure for preschoolers. Parents completed the sensory profile, which assesses the presence of child hypersensitivity (sensitivity and avoidant scale) and hyposensitivity (sensory seeking and registration scale). Results: Data showed that 57% of the children were presented with clinical symptoms of sensory regulation. In addition, 53% of the children were classified insecure behaviorally disorganized or insecure disorganized controlling. In particular, results revealed that children classified as insecure disorganized controlling were significantly more likely to show hypersensitivity avoidance and sensory-seeking behaviors. Conclusion: This study underscores the importance of the parent–child relationship for children with sensory regulation difficulties.

The ASQ and R-PDQ telephone-administered validation within the OTIS antidepressant in pregnancy study.

This study aimed to assess the telephone administration of the 12-month Ages and Stages Questionnaire (ASQ) and the 9- to 24-month Revised Prescreening Denver Questionnaire (R-PDQ) using the Antidepressants in Pregnancy Study cohort from the Organization of Teratology Information Specialists. The ASQ includes five domains (communication, gross motor, fine motor, problem-solving, and personal-social). The R-PDQ tests four areas of development (gross motor, fine motor, personal-social, and language). Both instruments were self and telephone-administered to mothers at 12 months postpartum. Concordance between the telephone and self-administration was assessed with intraclass correlation coefficients (ICCs) with 95% CIs. For the ASQ, concordance between test scores was substantial for the communication scale (ICC = 0.76, 95% CI [0.63, 0.85]), almost perfect for the gross motor scale (ICC = 0.83, 95% CI [0.73, 0.89]), and moderate for the fine motor, problem-solving, and personal-social scales (ICC = 0.43, 95% CI [0.19, 0.61]; ICC = 0.42, 95% CI [0.19, 0.61]; and ICC = 0.50, 95% CI [0.29, 0.67], respectively). Regarding the R-PDQ, concordance between test scores was as follows: gross motor (ICC = 0.90, 95% CI [0.83, 0.94]), language (ICC = 0.57, 95% CI [0.36, 0.73]), and personal-social scales (ICC = 0.26, 95% CI [0.00, 0.49]). For the fine motor scale, the correlation between both modes was 100%. The 12-month ASQ telephone administration could be an alternative for children developmental screening. Except the personal-social scale, the 9- to 24-month R-PDQ could be telephone-administered for prescreening development.