Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study

Objective: To investigate the association between antidepressant use in late gestation and postpartum haemorrhage (PPH). Design: Retrospective cohort study. Tertiary teaching hospital in Adelaide, Australia. Population: A total of 30 198 women delivering between 2002 and 2008. Methods: Relative risks adjusted for maternal sociodemographics and comorbidities (aRRs) were calculated for PPH, comparing women with late-gestation exposure to antidepressants (n = 558), women with a psychiatric illness but no antidepressant use (n = 1292), and women with neither antenatal exposures (n = 28 348). Additional sensitivity analyses were undertaken, examining associations with severe PPH and postpartum anaemia. Main Outcome Measures: The primary outcome was PPH, defined as a recorded blood loss of ≥500 mL for vaginal deliveries and ≥1000 mL for caesarean sections. Secondary outcomes included severe PPH (≥1000 mL blood loss, irrespective of method of delivery), and the presence of postpartum anaemia (identified from hospital medical records). Results: Compared with unexposed controls, women exposed to antidepressants had an increased risk of PPH (aRR 1.53; 95% confidence interval, 95% CI 1.25-1.86), whereas no increased risk was observed for women with a psychiatric illness but no antidepressant use (aRR 1.04; 95% CI 0.89-1.23). In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk of severe PPH (aRR 1.84; 95% CI 1.39-2.44), as well as postpartum anaemia (aRR 1.80; 95% CI 1.46-2.22). Conclusions: Exposure to antidepressants in late gestation was associated with a significantly increased risk of PPH. Although potential confounding by unmeasured factors cannot be ruled out, these findings suggest a direct effect of antidepressant exposure on PPH.LE Grzeskowiak, R McBain, GA Dekker, VL Clifto

Association of early and late maternal smoking during pregnancy with offspring body mass index at 4 to 5 years of age

The objective was to investigate the association between early and late maternal smoking during pregnancy on offspring body mass index (BMI). We undertook a retrospective cohort study using linked records from the Women's and Children's Health Network in South Australia. Among a cohort of women delivering a singleton, live-born infants between January 2000 and December 2005 (n=7658), 5961 reported not smoking during pregnancy, 297 reported quitting smoking during the first trimester of pregnancy, and 1400 reported continued smoking throughout pregnancy. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance programme. The main outcome measure was age- and sex-specific BMI z-score. At 4 to 5 years, mean (s.d.) BMI z-score was 0.40 (1.05), 0.60 (1.07) and 0.65 (1.18) in children of mothers who reported never smoking, quitting smoking and continued smoking during pregnancy, respectively. Compared with the group of non-smokers, both quitting smoking and continued smoking were associated with an increase in child BMI z-score of 0.15 (95% confidence interval: 0.01-0.29) and 0.21 (0.13-0.29), respectively. A significant dose-response relationship was also observed between the number of cigarettes smoked per day on average during the second half of pregnancy and the increase in offspring BMI z-score (P<0.001). In conclusion, any maternal smoking in pregnancy, even if mothers quit, is associated with an increase in offspring BMI at 4 to 5 years of age.L. E. Grzeskowiak, N. A. Hodyl, M. J. Stark, J. L. Morrison and V. L. Clifto

Authors' reply re: Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study

Luke E Grzeskowiak & Vicki L Clifto

Asthma management during pregnancy: how long before we can all breathe a little easier?

Letter to the EditorLuke E. Grzeskowiak, and Vicki L. Clifto

Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53-5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25-4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01-1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8%; p=0.201) These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone.Luke E. Grzeskowiak, Brian Smith, Anil Roy, Gustaaf A. Dekker and Vicki L. Clifto

Strategies towards improving pharmacological management of asthma during pregnancy

Abstract not availableLuke E.Grzeskowiak, Jessica A.Grieger, Vicki L.Clifto

Spherically symmetric solutions in f(R)-gravity via Noether Symmetry Approach

We search for spherically symmetric solutions of f(R) theories of gravity via the Noether Symmetry Approach. A general formalism in the metric framework is developed considering a point-like f(R)-Lagrangian where spherical symmetry is required. Examples of exact solutions are given.Comment: 17 pages, to appear in Class. Quant. Gra

Evolution of a periodic eight-black-hole lattice in numerical relativity

The idea of black-hole lattices as models for the large-scale structure of the universe has been under scrutiny for several decades, and some of the properties of these systems have been elucidated recently in the context of the problem of cosmological backreaction. The complete, three-dimensional and fully relativistic evolution of these system has, however, never been tackled. We explicitly construct the first of these solutions by numerically integrating Einstein's equation in the case of an eight-black-hole lattice with the topology of S3.Comment: 21 pages, 13 figures. Corrected and clarified discussio

Trajectories of anxiety and health related quality of life during pregnancy

Published: July 24, 2017Anxiety and health related Quality of Life (HRQoL) have emerged as important mental health measures in obstetric care. Few studies have systematically examined the longitudinal trajectories of anxiety and HRQoL in pregnancy. Using a linear growth modeling strategy, we analyzed the course of State-Trait Anxiety Inventory (STAI)- and Short Form (36) Health Survey (SF-36) scores between the 12th and the 36th week of gestation, in a sample of 355 women. We additionally analyzed the impact of depressive symptoms and a chronic medical condition (asthma), on STAI and SF-36 trajectory curves. STAI scores remained stable throughout pregnancy. A previous history of anxiety increased the overall STAI scores. Asthma and depressive symptoms scores had no impact on the STAI trajectory. Physical SF-36 scores decreased over the course of pregnancy, whereas mental SF-36 trended towards improvement. Asthma reduced physical SF-36 overall. While high depressive symptoms decreased the overall mental SF-36, they were also significantly associated with mental SF-36 improvements over time. Anxiety symptoms are stable during pregnancy and are not modulated by depressive symptoms or asthma. Physical HRQoL declines in pregnancy. In contrast, mental HRQoL appears to improve, particularly in women with high initial levels of depressive symptoms.K. Oliver Schubert, Tracy Air, Scott R. Clark, Luke E. Grzeskowiak, Edward Miller, Gustaaf A. Dekker, Bernhard T. Baune, Vicki L. Clifto

Renormalization group scale-setting from the action - a road to modified gravity theories

The renormalization group (RG) corrected gravitational action in Einstein-Hilbert and other truncations is considered. The running scale of the renormalization group is treated as a scalar field at the level of the action and determined in a scale-setting procedure recently introduced by Koch and Ramirez for the Einstein-Hilbert truncation. The scale-setting procedure is elaborated for other truncations of the gravitational action and applied to several phenomenologically interesting cases. It is shown how the logarithmic dependence of the Newton's coupling on the RG scale leads to exponentially suppressed effective cosmological constant and how the scale-setting in particular RG corrected gravitational theories yields the effective $f(R)$ modified gravity theories with negative powers of the Ricci scalar $R$. The scale-setting at the level of the action at the non-gaussian fixed point in Einstein-Hilbert and more general truncations is shown to lead to universal effective action quadratic in Ricci tensor.Comment: v1: 15 pages; v2: shortened to 10 pages, main results unchanged, published in Class. Quant. Gra