Obstetrics

Women who experience stillbirth or infant death have extraordinarily high rates of depression and anxiety, which are inadequately addressed, according to findings from the Michigan Mother’s Study.

The effects were particularly pronounced among African American women, according to Dr. Katherine J. Gold who will present the findings of her award-winning abstract on Wednesday at the annual meeting of the American Congress of Obstetricians and Gynecologists.

At 9 months after delivery, the rates of positive screens for a number of mental health issues were dramatically and statistically significantly higher in 377 bereaved women who experienced stillbirth or infant death in the first month, compared with 232 control mothers with live birth who participated in the 2-year longitudinal population-based cohort study. The rates were 23% vs. 8% for depression, 41% vs. 12% for posttraumatic stress disorder, 19% vs. 7% for general anxiety disorder, 19% vs. 6% for social phobia, and 12% vs. 6% for panic disorder for the groups, respectively, said Dr. Gold of the University of Michigan, Ann Arbor.

"These high rates of symptoms were significant even when controlling for demographic factors, prior mental health problems, social support, and interpersonal violence," Dr. Gold said in an interview.

Also, the rates of these mental health issues were similar among mothers who experienced stillbirth and those who experienced infant death, suggesting that both losses can be powerful and traumatic experiences.

Although bereaved African American women had similar levels of distress as other bereaved women, they were significantly less likely to have received treatment, Dr. Gold noted.

This study is the first population-based study to look at mental health outcomes among women who experience perinatal death.

"The findings suggest that bereaved mothers have dramatically higher levels of persistent distress, which may be underrecognized by health care providers. It is important for physicians and midwives to assess for mental health symptoms after a loss," she said adding that because it has been shown that depression during a subsequent pregnancy poses substantial risk to fetal and infant outcomes, identifying and treating depression in women before and during subsequent pregnancy is critical for improving outcomes.

Dr. Gold reported having no disclosures.

Women who experience stillbirth or infant death have extraordinarily high rates of depression and anxiety, which are inadequately addressed, according to findings from the Michigan Mother’s Study.

The effects were particularly pronounced among African American women, according to Dr. Katherine J. Gold who will present the findings of her award-winning abstract on Wednesday at the annual meeting of the American Congress of Obstetricians and Gynecologists.

At 9 months after delivery, the rates of positive screens for a number of mental health issues were dramatically and statistically significantly higher in 377 bereaved women who experienced stillbirth or infant death in the first month, compared with 232 control mothers with live birth who participated in the 2-year longitudinal population-based cohort study. The rates were 23% vs. 8% for depression, 41% vs. 12% for posttraumatic stress disorder, 19% vs. 7% for general anxiety disorder, 19% vs. 6% for social phobia, and 12% vs. 6% for panic disorder for the groups, respectively, said Dr. Gold of the University of Michigan, Ann Arbor.

"These high rates of symptoms were significant even when controlling for demographic factors, prior mental health problems, social support, and interpersonal violence," Dr. Gold said in an interview.

Also, the rates of these mental health issues were similar among mothers who experienced stillbirth and those who experienced infant death, suggesting that both losses can be powerful and traumatic experiences.

Although bereaved African American women had similar levels of distress as other bereaved women, they were significantly less likely to have received treatment, Dr. Gold noted.

This study is the first population-based study to look at mental health outcomes among women who experience perinatal death.

"The findings suggest that bereaved mothers have dramatically higher levels of persistent distress, which may be underrecognized by health care providers. It is important for physicians and midwives to assess for mental health symptoms after a loss," she said adding that because it has been shown that depression during a subsequent pregnancy poses substantial risk to fetal and infant outcomes, identifying and treating depression in women before and during subsequent pregnancy is critical for improving outcomes.

Dr. Gold reported having no disclosures.

Women who experience stillbirth or infant death have extraordinarily high rates of depression and anxiety, which are inadequately addressed, according to findings from the Michigan Mother’s Study.

The effects were particularly pronounced among African American women, according to Dr. Katherine J. Gold who will present the findings of her award-winning abstract on Wednesday at the annual meeting of the American Congress of Obstetricians and Gynecologists.

At 9 months after delivery, the rates of positive screens for a number of mental health issues were dramatically and statistically significantly higher in 377 bereaved women who experienced stillbirth or infant death in the first month, compared with 232 control mothers with live birth who participated in the 2-year longitudinal population-based cohort study. The rates were 23% vs. 8% for depression, 41% vs. 12% for posttraumatic stress disorder, 19% vs. 7% for general anxiety disorder, 19% vs. 6% for social phobia, and 12% vs. 6% for panic disorder for the groups, respectively, said Dr. Gold of the University of Michigan, Ann Arbor.

"These high rates of symptoms were significant even when controlling for demographic factors, prior mental health problems, social support, and interpersonal violence," Dr. Gold said in an interview.

Also, the rates of these mental health issues were similar among mothers who experienced stillbirth and those who experienced infant death, suggesting that both losses can be powerful and traumatic experiences.

Although bereaved African American women had similar levels of distress as other bereaved women, they were significantly less likely to have received treatment, Dr. Gold noted.

This study is the first population-based study to look at mental health outcomes among women who experience perinatal death.

"The findings suggest that bereaved mothers have dramatically higher levels of persistent distress, which may be underrecognized by health care providers. It is important for physicians and midwives to assess for mental health symptoms after a loss," she said adding that because it has been shown that depression during a subsequent pregnancy poses substantial risk to fetal and infant outcomes, identifying and treating depression in women before and during subsequent pregnancy is critical for improving outcomes.

Dr. Gold reported having no disclosures.

Women with twin pregnancies who have inadequate gestational weight gain during the second trimester have a more than twofold increase in the risk of preterm birth before 32 weeks, compared with those with adequate weight gain, findings from a retrospective cohort study suggest.

Inadequate weight gain between 20 and 28 weeks’ of gestation was the strongest predictor of preterm birth before 32 weeks in the study of 489 women with twin pregnancies, according to Dr. Kate E. Pettit, who will report the findings on Monday at the annual meeting of the American Congress of Obstetricians and Gynecologists in Chicago.

The rate of preterm birth prior to 32 weeks was 37.6% among women with inadequate weight gain during weeks 20-28, compared with 15.2% among those with adequate weight gain during that time period. Inadequate weight gain prior to 20 weeks was not associated with preterm birth, said Dr. Pettit of the University of California, San Diego, and her associates.

Other factors found to be associated with preterm birth in this study were monochorionicity and short cervical length, she noted.

All viable twin pregnancies delivered in the UCSD Health System between 2001 and 2013 were included in the study. Adequacy of weight gain was determined by dividing the minimum Institute of Medicine weight gain recommendation by 37 weeks.

"This study affirms the association between poor total gestational weight gain and preterm birth, and highlights the likely crucial period of time of 20-28 weeks of gestation that may be a target for future intervention trials," Dr. Pettit said in an interview.

The higher rate of preterm birth prior to 32 weeks’ of gestation among those with inadequate weight gain was attributable to spontaneous preterm birth, as there was no difference in the rates of indicated preterm birth among those with and without adequate weight gain, she explained, noting that "the biologic plausibility of the effect of gestational weight gain on the rate of spontaneous preterm birth is unknown."

"However, there is much room for improvement in gestational weight gain counseling, and a need for additional interventional trials to determine if adequacy of gestational weight gain at 20-28 weeks’ will, in fact, be one of the modifiable factors in the quest to reduce preterm birth in twin pregnancies," she said in an interview.

Interventions could include early goal-setting, nutritional assessment, and activity modification, she added.

Dr. Pettit reported having no disclosures.

Women with twin pregnancies who have inadequate gestational weight gain during the second trimester have a more than twofold increase in the risk of preterm birth before 32 weeks, compared with those with adequate weight gain, findings from a retrospective cohort study suggest.

Inadequate weight gain between 20 and 28 weeks’ of gestation was the strongest predictor of preterm birth before 32 weeks in the study of 489 women with twin pregnancies, according to Dr. Kate E. Pettit, who will report the findings on Monday at the annual meeting of the American Congress of Obstetricians and Gynecologists in Chicago.

The rate of preterm birth prior to 32 weeks was 37.6% among women with inadequate weight gain during weeks 20-28, compared with 15.2% among those with adequate weight gain during that time period. Inadequate weight gain prior to 20 weeks was not associated with preterm birth, said Dr. Pettit of the University of California, San Diego, and her associates.

Other factors found to be associated with preterm birth in this study were monochorionicity and short cervical length, she noted.

All viable twin pregnancies delivered in the UCSD Health System between 2001 and 2013 were included in the study. Adequacy of weight gain was determined by dividing the minimum Institute of Medicine weight gain recommendation by 37 weeks.

"This study affirms the association between poor total gestational weight gain and preterm birth, and highlights the likely crucial period of time of 20-28 weeks of gestation that may be a target for future intervention trials," Dr. Pettit said in an interview.

The higher rate of preterm birth prior to 32 weeks’ of gestation among those with inadequate weight gain was attributable to spontaneous preterm birth, as there was no difference in the rates of indicated preterm birth among those with and without adequate weight gain, she explained, noting that "the biologic plausibility of the effect of gestational weight gain on the rate of spontaneous preterm birth is unknown."

"However, there is much room for improvement in gestational weight gain counseling, and a need for additional interventional trials to determine if adequacy of gestational weight gain at 20-28 weeks’ will, in fact, be one of the modifiable factors in the quest to reduce preterm birth in twin pregnancies," she said in an interview.

Interventions could include early goal-setting, nutritional assessment, and activity modification, she added.

Dr. Pettit reported having no disclosures.

Women with twin pregnancies who have inadequate gestational weight gain during the second trimester have a more than twofold increase in the risk of preterm birth before 32 weeks, compared with those with adequate weight gain, findings from a retrospective cohort study suggest.

Inadequate weight gain between 20 and 28 weeks’ of gestation was the strongest predictor of preterm birth before 32 weeks in the study of 489 women with twin pregnancies, according to Dr. Kate E. Pettit, who will report the findings on Monday at the annual meeting of the American Congress of Obstetricians and Gynecologists in Chicago.

The rate of preterm birth prior to 32 weeks was 37.6% among women with inadequate weight gain during weeks 20-28, compared with 15.2% among those with adequate weight gain during that time period. Inadequate weight gain prior to 20 weeks was not associated with preterm birth, said Dr. Pettit of the University of California, San Diego, and her associates.

Other factors found to be associated with preterm birth in this study were monochorionicity and short cervical length, she noted.

All viable twin pregnancies delivered in the UCSD Health System between 2001 and 2013 were included in the study. Adequacy of weight gain was determined by dividing the minimum Institute of Medicine weight gain recommendation by 37 weeks.

"This study affirms the association between poor total gestational weight gain and preterm birth, and highlights the likely crucial period of time of 20-28 weeks of gestation that may be a target for future intervention trials," Dr. Pettit said in an interview.

The higher rate of preterm birth prior to 32 weeks’ of gestation among those with inadequate weight gain was attributable to spontaneous preterm birth, as there was no difference in the rates of indicated preterm birth among those with and without adequate weight gain, she explained, noting that "the biologic plausibility of the effect of gestational weight gain on the rate of spontaneous preterm birth is unknown."

"However, there is much room for improvement in gestational weight gain counseling, and a need for additional interventional trials to determine if adequacy of gestational weight gain at 20-28 weeks’ will, in fact, be one of the modifiable factors in the quest to reduce preterm birth in twin pregnancies," she said in an interview.

Interventions could include early goal-setting, nutritional assessment, and activity modification, she added.

Dr. Pettit reported having no disclosures.

Vaccines will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 premature deaths during the lifetimes of children born during the two decades after the Vaccines for Children Program began in 1994, according to a report released April 24 by the Centers for Disease Control and Prevention.

In addition, vaccines will save an estimated $295 billion in direct costs and $1.38 trillion in societal costs, according to the analysis, published in the April 25 issue of Morbidity and Mortality Weekly Report (MMWR 2014;61:352-5). The Vaccines for Children (VFC) Program, which provides recommended vaccines to about half the children in the United States, was created in 1993 in response to a resurgence of measles during 1989-1991, caused mostly by a failure to vaccinate uninsured children at the recommended age of 12-15 months.

©s-dmit/gettyimages.com

The VFC provides vaccines to children if they are eligible for Medicaid, are uninsured, or are American Indian or Alaskan native. Children who are underinsured and do not have vaccine coverage are also eligible. About half of the children in the United States receive vaccines through this program.

To estimate the program’s effect on health care costs and the health of all children born from 1994 to 2013, the Centers for Disease Control and Prevention (CDC) evaluated national data on immunization coverage, and used a cost-benefit model that estimated illnesses, hospitalizations, and premature deaths (not including influenza and hepatitis A).

Measles makes 2014 return

But a second MMWR report released April 24 described 58 confirmed measles cases in California during the first 4 months of this year, in children and adults from age 5 months to 60 years. That report illustrates some of the current vaccination challenges, particularly with cases related to people traveling to and from outside the United States.

California’s 58 measles cases were reported from January 2014 through April 16, 2014. It’s the highest number of cases reported for that calendar period in the state since 1995. The 129 cases reported in the United States during this period also were the largest number reported since 1996 (MMWR 2014;61:362-3). No deaths have been reported.

During a CDC media briefing on April 24, Dr. Anne Schuchat said that 34 of the 129 cases were imported cases, and occurred in residents traveling abroad or people traveling to the United States. Among those infected who were traveling to the United States, 17 people were from the Philippines, which is in the midst of a large measles outbreak – with about 20,000 confirmed or suspected cases, including 69 deaths, through February.

"Though not direct imports, most of the remaining cases are known to be linked to importation," said Dr. Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, and one of the authors of the VFC study.

The 129 cases of measles nationwide have been reported in 13 states. Cities and states with the highest number of cases are California, with 58 cases; New York City, with 24 cases; and Washington state, with 13 cases.

"While the story of the 1989 measles resurgence was one of poor children missing out on vaccines because they didn’t have insurance, today’s measles outbreaks are too often the result of people opting out" of vaccination, she said, noting that 84% of the cases have been in people who were not vaccinated or did not know if they had been vaccinated. This included 68% with personal-belief exemptions.

The California report shows the risk of measles spreading in health care settings, Dr. Schuchat noted. Of the California cases, 11 were transmitted in health care settings, including 6 in health care personnel.

Most of the 58 measles cases in California this year were in people who were not vaccinated (43%) or could not document that they had been vaccinated (31%), according to the report. The 25 patients who were not vaccinated included 19 who had philosophical objections to vaccination, and 3 who were too young for the vaccine. But 19% – two children and nine adults – had received two or more doses of MMR vaccine.

Most cases – 54 (93%) – were associated with imported cases, and included 13 cases of U.S. residents who had traveled internationally, 8 to the Philippines.

Travelers should vaccinate

The increase in imported cases from the Philippines "and subsequent transmission in certain settings in the United States highlight the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level," according to the report’s authors.

The researchers also recommend that all residents of the United States born after 1956 make sure they have received the MMR vaccine "or have serologic evidence of measles immunity."

If individuals do not have serologic evidence of immunity and are traveling outside of North America or South America, the CDC recommends one dose of MMR vaccine for infants aged 6-11 months, and two doses of MMR vaccine at least 28 days apart in children aged 1 year and older, and in adults.

There were no author disclosures for either report.

Vaccines will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 premature deaths during the lifetimes of children born during the two decades after the Vaccines for Children Program began in 1994, according to a report released April 24 by the Centers for Disease Control and Prevention.

In addition, vaccines will save an estimated $295 billion in direct costs and $1.38 trillion in societal costs, according to the analysis, published in the April 25 issue of Morbidity and Mortality Weekly Report (MMWR 2014;61:352-5). The Vaccines for Children (VFC) Program, which provides recommended vaccines to about half the children in the United States, was created in 1993 in response to a resurgence of measles during 1989-1991, caused mostly by a failure to vaccinate uninsured children at the recommended age of 12-15 months.

©s-dmit/gettyimages.com

The VFC provides vaccines to children if they are eligible for Medicaid, are uninsured, or are American Indian or Alaskan native. Children who are underinsured and do not have vaccine coverage are also eligible. About half of the children in the United States receive vaccines through this program.

To estimate the program’s effect on health care costs and the health of all children born from 1994 to 2013, the Centers for Disease Control and Prevention (CDC) evaluated national data on immunization coverage, and used a cost-benefit model that estimated illnesses, hospitalizations, and premature deaths (not including influenza and hepatitis A).

Measles makes 2014 return

But a second MMWR report released April 24 described 58 confirmed measles cases in California during the first 4 months of this year, in children and adults from age 5 months to 60 years. That report illustrates some of the current vaccination challenges, particularly with cases related to people traveling to and from outside the United States.

California’s 58 measles cases were reported from January 2014 through April 16, 2014. It’s the highest number of cases reported for that calendar period in the state since 1995. The 129 cases reported in the United States during this period also were the largest number reported since 1996 (MMWR 2014;61:362-3). No deaths have been reported.

During a CDC media briefing on April 24, Dr. Anne Schuchat said that 34 of the 129 cases were imported cases, and occurred in residents traveling abroad or people traveling to the United States. Among those infected who were traveling to the United States, 17 people were from the Philippines, which is in the midst of a large measles outbreak – with about 20,000 confirmed or suspected cases, including 69 deaths, through February.

"Though not direct imports, most of the remaining cases are known to be linked to importation," said Dr. Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, and one of the authors of the VFC study.

The 129 cases of measles nationwide have been reported in 13 states. Cities and states with the highest number of cases are California, with 58 cases; New York City, with 24 cases; and Washington state, with 13 cases.

"While the story of the 1989 measles resurgence was one of poor children missing out on vaccines because they didn’t have insurance, today’s measles outbreaks are too often the result of people opting out" of vaccination, she said, noting that 84% of the cases have been in people who were not vaccinated or did not know if they had been vaccinated. This included 68% with personal-belief exemptions.

The California report shows the risk of measles spreading in health care settings, Dr. Schuchat noted. Of the California cases, 11 were transmitted in health care settings, including 6 in health care personnel.

Most of the 58 measles cases in California this year were in people who were not vaccinated (43%) or could not document that they had been vaccinated (31%), according to the report. The 25 patients who were not vaccinated included 19 who had philosophical objections to vaccination, and 3 who were too young for the vaccine. But 19% – two children and nine adults – had received two or more doses of MMR vaccine.

Most cases – 54 (93%) – were associated with imported cases, and included 13 cases of U.S. residents who had traveled internationally, 8 to the Philippines.

Travelers should vaccinate

The increase in imported cases from the Philippines "and subsequent transmission in certain settings in the United States highlight the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level," according to the report’s authors.

The researchers also recommend that all residents of the United States born after 1956 make sure they have received the MMR vaccine "or have serologic evidence of measles immunity."

If individuals do not have serologic evidence of immunity and are traveling outside of North America or South America, the CDC recommends one dose of MMR vaccine for infants aged 6-11 months, and two doses of MMR vaccine at least 28 days apart in children aged 1 year and older, and in adults.

There were no author disclosures for either report.

Vaccines will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 premature deaths during the lifetimes of children born during the two decades after the Vaccines for Children Program began in 1994, according to a report released April 24 by the Centers for Disease Control and Prevention.

In addition, vaccines will save an estimated $295 billion in direct costs and $1.38 trillion in societal costs, according to the analysis, published in the April 25 issue of Morbidity and Mortality Weekly Report (MMWR 2014;61:352-5). The Vaccines for Children (VFC) Program, which provides recommended vaccines to about half the children in the United States, was created in 1993 in response to a resurgence of measles during 1989-1991, caused mostly by a failure to vaccinate uninsured children at the recommended age of 12-15 months.

©s-dmit/gettyimages.com

The VFC provides vaccines to children if they are eligible for Medicaid, are uninsured, or are American Indian or Alaskan native. Children who are underinsured and do not have vaccine coverage are also eligible. About half of the children in the United States receive vaccines through this program.

To estimate the program’s effect on health care costs and the health of all children born from 1994 to 2013, the Centers for Disease Control and Prevention (CDC) evaluated national data on immunization coverage, and used a cost-benefit model that estimated illnesses, hospitalizations, and premature deaths (not including influenza and hepatitis A).

Measles makes 2014 return

But a second MMWR report released April 24 described 58 confirmed measles cases in California during the first 4 months of this year, in children and adults from age 5 months to 60 years. That report illustrates some of the current vaccination challenges, particularly with cases related to people traveling to and from outside the United States.

California’s 58 measles cases were reported from January 2014 through April 16, 2014. It’s the highest number of cases reported for that calendar period in the state since 1995. The 129 cases reported in the United States during this period also were the largest number reported since 1996 (MMWR 2014;61:362-3). No deaths have been reported.

During a CDC media briefing on April 24, Dr. Anne Schuchat said that 34 of the 129 cases were imported cases, and occurred in residents traveling abroad or people traveling to the United States. Among those infected who were traveling to the United States, 17 people were from the Philippines, which is in the midst of a large measles outbreak – with about 20,000 confirmed or suspected cases, including 69 deaths, through February.

"Though not direct imports, most of the remaining cases are known to be linked to importation," said Dr. Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, and one of the authors of the VFC study.

The 129 cases of measles nationwide have been reported in 13 states. Cities and states with the highest number of cases are California, with 58 cases; New York City, with 24 cases; and Washington state, with 13 cases.

"While the story of the 1989 measles resurgence was one of poor children missing out on vaccines because they didn’t have insurance, today’s measles outbreaks are too often the result of people opting out" of vaccination, she said, noting that 84% of the cases have been in people who were not vaccinated or did not know if they had been vaccinated. This included 68% with personal-belief exemptions.

The California report shows the risk of measles spreading in health care settings, Dr. Schuchat noted. Of the California cases, 11 were transmitted in health care settings, including 6 in health care personnel.

Most of the 58 measles cases in California this year were in people who were not vaccinated (43%) or could not document that they had been vaccinated (31%), according to the report. The 25 patients who were not vaccinated included 19 who had philosophical objections to vaccination, and 3 who were too young for the vaccine. But 19% – two children and nine adults – had received two or more doses of MMR vaccine.

Most cases – 54 (93%) – were associated with imported cases, and included 13 cases of U.S. residents who had traveled internationally, 8 to the Philippines.

Travelers should vaccinate

The increase in imported cases from the Philippines "and subsequent transmission in certain settings in the United States highlight the importance of ensuring age-appropriate vaccination for persons traveling to areas where measles is endemic and maintaining high vaccination coverage at the national and local level," according to the report’s authors.

The researchers also recommend that all residents of the United States born after 1956 make sure they have received the MMR vaccine "or have serologic evidence of measles immunity."

If individuals do not have serologic evidence of immunity and are traveling outside of North America or South America, the CDC recommends one dose of MMR vaccine for infants aged 6-11 months, and two doses of MMR vaccine at least 28 days apart in children aged 1 year and older, and in adults.

There were no author disclosures for either report.

CHICAGO – If you’re currently treating any pregnant patients who are taking atypical antipsychotics, Dr. Marlene P. Freeman and her colleagues, who’ve started a national registry for tracking these data, hope to hear from you.

"We also need information not just on patients who are taking antipsychotics but also on those who aren’t, so that we can expand the number of controls," Dr. Freeman said in an interview during Psychiatry Update 2014, cosponsored by the American Academy of Clinical Psychiatrists and Current Psychiatry.

"Our registry is carefully, prospectively done," said Dr. Freeman while speaking at the meeting. "It’s all done by phone, with two calls during pregnancy and one post partum."

Findings based on data collected before June 2013 and presented at a teratogenicity meeting last year were "not unblinded in terms of what medications were associated with what outcomes or who the controls were," she said. However, so far the trend is that antipsychotic use isn’t likely going to turn out to be as adverse as valproic acid, the anticonvulsant that ultimately was found associated with teratogenicity, said Dr. Freeman, who is the clinical director of Women’s Mental Health Center at Massachusetts General Hospital in Boston, where the registry is housed. "Rates of malformations [found in the registry data so far] were at or below the rates in the general population," she said, adding that definitive results are still needed.

At this time, more than 400 patients are enrolled in the registry, which began in 2011 in an effort to build a definitive database on teratogenicity and atypicals in pregnancy. According to Dr. Freeman, a German study published recently showed no significant difference between rates of major malformations between those exposed to first-generation antipsychotics or second-generation atypicals during the first trimester (J. Clin. Psychopharm. 2013;33:453-62). However, compared with controls, the major malformation rate was just over two times greater among those exposed to atypicals.

Meanwhile, a prospective Canadian study also cited by Dr. Freeman did not find a significant difference in congenital malformations between children born to mothers taking atypicals, compared with controls (BMJ Open 2013;3:e003062 [doi:10.1136/bmjopen-2013-003062]).

According to Dr. Freeman, the need for clear, substantial data is important, because the use of atypicals in pregnancy is on the rise. A study published last year and cited by Dr. Freeman found that among 585,615 U.S. deliveries that occurred during 2001-2007 with prescriptions dispensed to the mother between 60 days before or on the date of delivery, 0.72% received an atypical antipsychotic and 0.09% received a typical antipsychotic (Arch. Womens Ment. Health 2013;16:149-57). There was a 2.5-fold increase in atypicals prescribed over the course of the study period. Depression was the most common mental health diagnosis (63%), followed by bipolar disorder (43%), and schizophrenia (13%).

Dr. Freeman disclosed she has industry relationships with GlaxoSmithKline, Takeda/Lundbeck, and Genentech, among others. Current Psychiatry and this news organization are owned by the same parent company.

For more information on the National Pregnancy Registry, click here.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

CHICAGO – If you’re currently treating any pregnant patients who are taking atypical antipsychotics, Dr. Marlene P. Freeman and her colleagues, who’ve started a national registry for tracking these data, hope to hear from you.

"We also need information not just on patients who are taking antipsychotics but also on those who aren’t, so that we can expand the number of controls," Dr. Freeman said in an interview during Psychiatry Update 2014, cosponsored by the American Academy of Clinical Psychiatrists and Current Psychiatry.

"Our registry is carefully, prospectively done," said Dr. Freeman while speaking at the meeting. "It’s all done by phone, with two calls during pregnancy and one post partum."

Findings based on data collected before June 2013 and presented at a teratogenicity meeting last year were "not unblinded in terms of what medications were associated with what outcomes or who the controls were," she said. However, so far the trend is that antipsychotic use isn’t likely going to turn out to be as adverse as valproic acid, the anticonvulsant that ultimately was found associated with teratogenicity, said Dr. Freeman, who is the clinical director of Women’s Mental Health Center at Massachusetts General Hospital in Boston, where the registry is housed. "Rates of malformations [found in the registry data so far] were at or below the rates in the general population," she said, adding that definitive results are still needed.

At this time, more than 400 patients are enrolled in the registry, which began in 2011 in an effort to build a definitive database on teratogenicity and atypicals in pregnancy. According to Dr. Freeman, a German study published recently showed no significant difference between rates of major malformations between those exposed to first-generation antipsychotics or second-generation atypicals during the first trimester (J. Clin. Psychopharm. 2013;33:453-62). However, compared with controls, the major malformation rate was just over two times greater among those exposed to atypicals.

Meanwhile, a prospective Canadian study also cited by Dr. Freeman did not find a significant difference in congenital malformations between children born to mothers taking atypicals, compared with controls (BMJ Open 2013;3:e003062 [doi:10.1136/bmjopen-2013-003062]).

According to Dr. Freeman, the need for clear, substantial data is important, because the use of atypicals in pregnancy is on the rise. A study published last year and cited by Dr. Freeman found that among 585,615 U.S. deliveries that occurred during 2001-2007 with prescriptions dispensed to the mother between 60 days before or on the date of delivery, 0.72% received an atypical antipsychotic and 0.09% received a typical antipsychotic (Arch. Womens Ment. Health 2013;16:149-57). There was a 2.5-fold increase in atypicals prescribed over the course of the study period. Depression was the most common mental health diagnosis (63%), followed by bipolar disorder (43%), and schizophrenia (13%).

Dr. Freeman disclosed she has industry relationships with GlaxoSmithKline, Takeda/Lundbeck, and Genentech, among others. Current Psychiatry and this news organization are owned by the same parent company.

For more information on the National Pregnancy Registry, click here.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

CHICAGO – If you’re currently treating any pregnant patients who are taking atypical antipsychotics, Dr. Marlene P. Freeman and her colleagues, who’ve started a national registry for tracking these data, hope to hear from you.

"We also need information not just on patients who are taking antipsychotics but also on those who aren’t, so that we can expand the number of controls," Dr. Freeman said in an interview during Psychiatry Update 2014, cosponsored by the American Academy of Clinical Psychiatrists and Current Psychiatry.

"Our registry is carefully, prospectively done," said Dr. Freeman while speaking at the meeting. "It’s all done by phone, with two calls during pregnancy and one post partum."

Findings based on data collected before June 2013 and presented at a teratogenicity meeting last year were "not unblinded in terms of what medications were associated with what outcomes or who the controls were," she said. However, so far the trend is that antipsychotic use isn’t likely going to turn out to be as adverse as valproic acid, the anticonvulsant that ultimately was found associated with teratogenicity, said Dr. Freeman, who is the clinical director of Women’s Mental Health Center at Massachusetts General Hospital in Boston, where the registry is housed. "Rates of malformations [found in the registry data so far] were at or below the rates in the general population," she said, adding that definitive results are still needed.

At this time, more than 400 patients are enrolled in the registry, which began in 2011 in an effort to build a definitive database on teratogenicity and atypicals in pregnancy. According to Dr. Freeman, a German study published recently showed no significant difference between rates of major malformations between those exposed to first-generation antipsychotics or second-generation atypicals during the first trimester (J. Clin. Psychopharm. 2013;33:453-62). However, compared with controls, the major malformation rate was just over two times greater among those exposed to atypicals.

Meanwhile, a prospective Canadian study also cited by Dr. Freeman did not find a significant difference in congenital malformations between children born to mothers taking atypicals, compared with controls (BMJ Open 2013;3:e003062 [doi:10.1136/bmjopen-2013-003062]).

According to Dr. Freeman, the need for clear, substantial data is important, because the use of atypicals in pregnancy is on the rise. A study published last year and cited by Dr. Freeman found that among 585,615 U.S. deliveries that occurred during 2001-2007 with prescriptions dispensed to the mother between 60 days before or on the date of delivery, 0.72% received an atypical antipsychotic and 0.09% received a typical antipsychotic (Arch. Womens Ment. Health 2013;16:149-57). There was a 2.5-fold increase in atypicals prescribed over the course of the study period. Depression was the most common mental health diagnosis (63%), followed by bipolar disorder (43%), and schizophrenia (13%).

Dr. Freeman disclosed she has industry relationships with GlaxoSmithKline, Takeda/Lundbeck, and Genentech, among others. Current Psychiatry and this news organization are owned by the same parent company.

For more information on the National Pregnancy Registry, click here.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

CHICAGO – The Food and Drug Administration’s letter rating scale is "unreliable" when it comes to prescribing antidepressants for pregnant women, according to Dr. Marlene P. Freeman, director of clinical services for the perinatal and reproductive psychiatry clinical research program at Massachusetts General Hospital in Boston.

"It’s actually very important to disregard those letters and turn to actual data when making clinical decisions, which can be very difficult for the individual practitioner who doesn’t specialize in this area," Dr. Freeman said in an interview during Psychiatry Update 2014, sponsored by Current Psychiatry and the American Academy of Clinical Psychiatrists.

Other concerns Dr. Freeman thinks clinicians treating pregnant women with depression need to be aware of include which SSRIs can lead to cardiovascular malformations in the child, as well as which ones have been associated with spontaneous abortions. Dr. Freeman also discusses what supplementation offers promise for preventing autism, and when omega-3 fatty acid supplementation is appropriate for first-line therapy in depression.

Current Psychiatry and this news organization are owned by the same parent company.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

CHICAGO – The Food and Drug Administration’s letter rating scale is "unreliable" when it comes to prescribing antidepressants for pregnant women, according to Dr. Marlene P. Freeman, director of clinical services for the perinatal and reproductive psychiatry clinical research program at Massachusetts General Hospital in Boston.

"It’s actually very important to disregard those letters and turn to actual data when making clinical decisions, which can be very difficult for the individual practitioner who doesn’t specialize in this area," Dr. Freeman said in an interview during Psychiatry Update 2014, sponsored by Current Psychiatry and the American Academy of Clinical Psychiatrists.

Other concerns Dr. Freeman thinks clinicians treating pregnant women with depression need to be aware of include which SSRIs can lead to cardiovascular malformations in the child, as well as which ones have been associated with spontaneous abortions. Dr. Freeman also discusses what supplementation offers promise for preventing autism, and when omega-3 fatty acid supplementation is appropriate for first-line therapy in depression.

Current Psychiatry and this news organization are owned by the same parent company.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

CHICAGO – The Food and Drug Administration’s letter rating scale is "unreliable" when it comes to prescribing antidepressants for pregnant women, according to Dr. Marlene P. Freeman, director of clinical services for the perinatal and reproductive psychiatry clinical research program at Massachusetts General Hospital in Boston.

"It’s actually very important to disregard those letters and turn to actual data when making clinical decisions, which can be very difficult for the individual practitioner who doesn’t specialize in this area," Dr. Freeman said in an interview during Psychiatry Update 2014, sponsored by Current Psychiatry and the American Academy of Clinical Psychiatrists.

Other concerns Dr. Freeman thinks clinicians treating pregnant women with depression need to be aware of include which SSRIs can lead to cardiovascular malformations in the child, as well as which ones have been associated with spontaneous abortions. Dr. Freeman also discusses what supplementation offers promise for preventing autism, and when omega-3 fatty acid supplementation is appropriate for first-line therapy in depression.

Current Psychiatry and this news organization are owned by the same parent company.

wmcknight@frontlinemedcom.com

On Twitter @whitneymcknight

Increasing maternal body mass index shows a moderate to strong dose-response relationship with increasing risks of fetal death, stillbirth, neonatal death, perinatal death, and infant death, according to a report published online April 15 in JAMA.

In what they described as the first meta-analysis to comprehensively summarize the findings regarding maternal overweight and obesity on the one hand and infant mortality risks on the other, researchers compiled data from 38 cohort studies that tallied at least three categories of maternal BMI as well as several separate infant mortality outcomes. Most of the studies were performed in Europe (19) and North America (6), but there also were 6 from Australia, 4 from Asia, 2 from Latin America, and 1 from Africa.

Keith Brofsky/Thinkstock

Together, these studies included 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11,294 neonatal deaths, and 4,983 infant deaths, and most accounted for potentially confounding factors such as maternal age, parity, and smoking status, lending this meta-analysis the statistical power to specifically quantify mortality risks, said Dagfinn Aune of the department of epidemiology and biostatistics, Imperial College London School of Public Health, and his associates.

Even modest increases in maternal BMI were linked with increases in the risk of every category of infant mortality. In a linear dose-response analysis, the relative risk ranged between 1.15 and 1.24 for every 5-unit increase in maternal BMI. "The greatest risk was observed in the category of severely obese women; women with a BMI of 40 had an approximately two- to threefold increase in the [relative risk] of these outcomes vs. a BMI of 20, with absolute risks in the range of 0.69% to 2.7% for BMI of 40 vs. 0.20% to 0.76% for BMI of 20," the investigators said (JAMA 2014 April 15 [doi:10/1001/jama.2014.2269]).

The dose-response nature of this relationship suggests an underlying biological connection between maternal adiposity and infant death. Maternal obesity is known to raise the risk of preeclampsia, gestational diabetes, type 2 diabetes, gestational hypertension, and congenital anomalies, which may in turn raise the risk of infant death. It is also associated with increased inflammatory responses, vascular and endothelial dysfunction, and altered lipid metabolism, which can in turn raise the risk of placental thrombosis, decrease placental perfusion, and lead to placental infarction or abruption in late pregnancy. Finally, maternal obesity is associated with macrosomia, which in turn is related to asphyxia, infection, and infant death, Mr. Aune and his associates said.

This study was supported by the Norwegian SIDS and Stillbirth Society. Mr. Aune and his associates reported no financial conflicts of interest.

Increasing maternal body mass index shows a moderate to strong dose-response relationship with increasing risks of fetal death, stillbirth, neonatal death, perinatal death, and infant death, according to a report published online April 15 in JAMA.

In what they described as the first meta-analysis to comprehensively summarize the findings regarding maternal overweight and obesity on the one hand and infant mortality risks on the other, researchers compiled data from 38 cohort studies that tallied at least three categories of maternal BMI as well as several separate infant mortality outcomes. Most of the studies were performed in Europe (19) and North America (6), but there also were 6 from Australia, 4 from Asia, 2 from Latin America, and 1 from Africa.

Keith Brofsky/Thinkstock

Together, these studies included 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11,294 neonatal deaths, and 4,983 infant deaths, and most accounted for potentially confounding factors such as maternal age, parity, and smoking status, lending this meta-analysis the statistical power to specifically quantify mortality risks, said Dagfinn Aune of the department of epidemiology and biostatistics, Imperial College London School of Public Health, and his associates.

Even modest increases in maternal BMI were linked with increases in the risk of every category of infant mortality. In a linear dose-response analysis, the relative risk ranged between 1.15 and 1.24 for every 5-unit increase in maternal BMI. "The greatest risk was observed in the category of severely obese women; women with a BMI of 40 had an approximately two- to threefold increase in the [relative risk] of these outcomes vs. a BMI of 20, with absolute risks in the range of 0.69% to 2.7% for BMI of 40 vs. 0.20% to 0.76% for BMI of 20," the investigators said (JAMA 2014 April 15 [doi:10/1001/jama.2014.2269]).

The dose-response nature of this relationship suggests an underlying biological connection between maternal adiposity and infant death. Maternal obesity is known to raise the risk of preeclampsia, gestational diabetes, type 2 diabetes, gestational hypertension, and congenital anomalies, which may in turn raise the risk of infant death. It is also associated with increased inflammatory responses, vascular and endothelial dysfunction, and altered lipid metabolism, which can in turn raise the risk of placental thrombosis, decrease placental perfusion, and lead to placental infarction or abruption in late pregnancy. Finally, maternal obesity is associated with macrosomia, which in turn is related to asphyxia, infection, and infant death, Mr. Aune and his associates said.

This study was supported by the Norwegian SIDS and Stillbirth Society. Mr. Aune and his associates reported no financial conflicts of interest.

Increasing maternal body mass index shows a moderate to strong dose-response relationship with increasing risks of fetal death, stillbirth, neonatal death, perinatal death, and infant death, according to a report published online April 15 in JAMA.

In what they described as the first meta-analysis to comprehensively summarize the findings regarding maternal overweight and obesity on the one hand and infant mortality risks on the other, researchers compiled data from 38 cohort studies that tallied at least three categories of maternal BMI as well as several separate infant mortality outcomes. Most of the studies were performed in Europe (19) and North America (6), but there also were 6 from Australia, 4 from Asia, 2 from Latin America, and 1 from Africa.

Keith Brofsky/Thinkstock

Together, these studies included 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11,294 neonatal deaths, and 4,983 infant deaths, and most accounted for potentially confounding factors such as maternal age, parity, and smoking status, lending this meta-analysis the statistical power to specifically quantify mortality risks, said Dagfinn Aune of the department of epidemiology and biostatistics, Imperial College London School of Public Health, and his associates.

Even modest increases in maternal BMI were linked with increases in the risk of every category of infant mortality. In a linear dose-response analysis, the relative risk ranged between 1.15 and 1.24 for every 5-unit increase in maternal BMI. "The greatest risk was observed in the category of severely obese women; women with a BMI of 40 had an approximately two- to threefold increase in the [relative risk] of these outcomes vs. a BMI of 20, with absolute risks in the range of 0.69% to 2.7% for BMI of 40 vs. 0.20% to 0.76% for BMI of 20," the investigators said (JAMA 2014 April 15 [doi:10/1001/jama.2014.2269]).

The dose-response nature of this relationship suggests an underlying biological connection between maternal adiposity and infant death. Maternal obesity is known to raise the risk of preeclampsia, gestational diabetes, type 2 diabetes, gestational hypertension, and congenital anomalies, which may in turn raise the risk of infant death. It is also associated with increased inflammatory responses, vascular and endothelial dysfunction, and altered lipid metabolism, which can in turn raise the risk of placental thrombosis, decrease placental perfusion, and lead to placental infarction or abruption in late pregnancy. Finally, maternal obesity is associated with macrosomia, which in turn is related to asphyxia, infection, and infant death, Mr. Aune and his associates said.

This study was supported by the Norwegian SIDS and Stillbirth Society. Mr. Aune and his associates reported no financial conflicts of interest.

Increasing maternal body mass index shows a moderate to strong dose-response relationship with increasing risks of fetal death, stillbirth, neonatal death, perinatal death, and infant death, according to a report published online April 15 in JAMA.

In what they described as the first meta-analysis to comprehensively summarize the findings regarding maternal overweight and obesity on the one hand and infant mortality risks on the other, researchers compiled data from 38 cohort studies that tallied at least three categories of maternal BMI as well as several separate infant mortality outcomes. Most of the studies were performed in Europe (19) and North America (6), but there also were 6 from Australia, 4 from Asia, 2 from Latin America, and 1 from Africa.

Keith Brofsky/Thinkstock

Together, these studies included 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11,294 neonatal deaths, and 4,983 infant deaths, and most accounted for potentially confounding factors such as maternal age, parity, and smoking status, lending this meta-analysis the statistical power to specifically quantify mortality risks, said Dagfinn Aune of the department of epidemiology and biostatistics, Imperial College London School of Public Health, and his associates.

Even modest increases in maternal BMI were linked with increases in the risk of every category of infant mortality. In a linear dose-response analysis, the relative risk ranged between 1.15 and 1.24 for every 5-unit increase in maternal BMI. "The greatest risk was observed in the category of severely obese women; women with a BMI of 40 had an approximately two- to threefold increase in the [relative risk] of these outcomes vs. a BMI of 20, with absolute risks in the range of 0.69% to 2.7% for BMI of 40 vs. 0.20% to 0.76% for BMI of 20," the investigators said (JAMA 2014 April 15 [doi:10/1001/jama.2014.2269]).

The dose-response nature of this relationship suggests an underlying biological connection between maternal adiposity and infant death. Maternal obesity is known to raise the risk of preeclampsia, gestational diabetes, type 2 diabetes, gestational hypertension, and congenital anomalies, which may in turn raise the risk of infant death. It is also associated with increased inflammatory responses, vascular and endothelial dysfunction, and altered lipid metabolism, which can in turn raise the risk of placental thrombosis, decrease placental perfusion, and lead to placental infarction or abruption in late pregnancy. Finally, maternal obesity is associated with macrosomia, which in turn is related to asphyxia, infection, and infant death, Mr. Aune and his associates said.

This study was supported by the Norwegian SIDS and Stillbirth Society. Mr. Aune and his associates reported no financial conflicts of interest.

Increasing maternal body mass index shows a moderate to strong dose-response relationship with increasing risks of fetal death, stillbirth, neonatal death, perinatal death, and infant death, according to a report published online April 15 in JAMA.

In what they described as the first meta-analysis to comprehensively summarize the findings regarding maternal overweight and obesity on the one hand and infant mortality risks on the other, researchers compiled data from 38 cohort studies that tallied at least three categories of maternal BMI as well as several separate infant mortality outcomes. Most of the studies were performed in Europe (19) and North America (6), but there also were 6 from Australia, 4 from Asia, 2 from Latin America, and 1 from Africa.

Keith Brofsky/Thinkstock

Together, these studies included 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11,294 neonatal deaths, and 4,983 infant deaths, and most accounted for potentially confounding factors such as maternal age, parity, and smoking status, lending this meta-analysis the statistical power to specifically quantify mortality risks, said Dagfinn Aune of the department of epidemiology and biostatistics, Imperial College London School of Public Health, and his associates.

Even modest increases in maternal BMI were linked with increases in the risk of every category of infant mortality. In a linear dose-response analysis, the relative risk ranged between 1.15 and 1.24 for every 5-unit increase in maternal BMI. "The greatest risk was observed in the category of severely obese women; women with a BMI of 40 had an approximately two- to threefold increase in the [relative risk] of these outcomes vs. a BMI of 20, with absolute risks in the range of 0.69% to 2.7% for BMI of 40 vs. 0.20% to 0.76% for BMI of 20," the investigators said (JAMA 2014 April 15 [doi:10/1001/jama.2014.2269]).

The dose-response nature of this relationship suggests an underlying biological connection between maternal adiposity and infant death. Maternal obesity is known to raise the risk of preeclampsia, gestational diabetes, type 2 diabetes, gestational hypertension, and congenital anomalies, which may in turn raise the risk of infant death. It is also associated with increased inflammatory responses, vascular and endothelial dysfunction, and altered lipid metabolism, which can in turn raise the risk of placental thrombosis, decrease placental perfusion, and lead to placental infarction or abruption in late pregnancy. Finally, maternal obesity is associated with macrosomia, which in turn is related to asphyxia, infection, and infant death, Mr. Aune and his associates said.

This study was supported by the Norwegian SIDS and Stillbirth Society. Mr. Aune and his associates reported no financial conflicts of interest.

Increasing maternal body mass index shows a moderate to strong dose-response relationship with increasing risks of fetal death, stillbirth, neonatal death, perinatal death, and infant death, according to a report published online April 15 in JAMA.

In what they described as the first meta-analysis to comprehensively summarize the findings regarding maternal overweight and obesity on the one hand and infant mortality risks on the other, researchers compiled data from 38 cohort studies that tallied at least three categories of maternal BMI as well as several separate infant mortality outcomes. Most of the studies were performed in Europe (19) and North America (6), but there also were 6 from Australia, 4 from Asia, 2 from Latin America, and 1 from Africa.

Keith Brofsky/Thinkstock

Together, these studies included 10,147 fetal deaths, 16,274 stillbirths, 4,311 perinatal deaths, 11,294 neonatal deaths, and 4,983 infant deaths, and most accounted for potentially confounding factors such as maternal age, parity, and smoking status, lending this meta-analysis the statistical power to specifically quantify mortality risks, said Dagfinn Aune of the department of epidemiology and biostatistics, Imperial College London School of Public Health, and his associates.

Even modest increases in maternal BMI were linked with increases in the risk of every category of infant mortality. In a linear dose-response analysis, the relative risk ranged between 1.15 and 1.24 for every 5-unit increase in maternal BMI. "The greatest risk was observed in the category of severely obese women; women with a BMI of 40 had an approximately two- to threefold increase in the [relative risk] of these outcomes vs. a BMI of 20, with absolute risks in the range of 0.69% to 2.7% for BMI of 40 vs. 0.20% to 0.76% for BMI of 20," the investigators said (JAMA 2014 April 15 [doi:10/1001/jama.2014.2269]).

The dose-response nature of this relationship suggests an underlying biological connection between maternal adiposity and infant death. Maternal obesity is known to raise the risk of preeclampsia, gestational diabetes, type 2 diabetes, gestational hypertension, and congenital anomalies, which may in turn raise the risk of infant death. It is also associated with increased inflammatory responses, vascular and endothelial dysfunction, and altered lipid metabolism, which can in turn raise the risk of placental thrombosis, decrease placental perfusion, and lead to placental infarction or abruption in late pregnancy. Finally, maternal obesity is associated with macrosomia, which in turn is related to asphyxia, infection, and infant death, Mr. Aune and his associates said.

This study was supported by the Norwegian SIDS and Stillbirth Society. Mr. Aune and his associates reported no financial conflicts of interest.