Drug use during pregnancy with focus on antidepressants

Background: More than half of pregnant women use at least one prescribed medication during pregnancy, and almost all pregnant women use some kind of over-the-counter medication. Depression is one of the most common diseases in the world today, also during the peripartum period. The prevalence of pregnant women using antidepressant medication is increasing. General knowledge about the use of medication during pregnancy needs to improve. The overall aim of the studies on which this thesis is based is therefore to examine different aspects of medication use during pregnancy, with a focus on antidepressants. Material and methods: Study I was a questionnaire study where 850 pregnant women were asked about their perceptions on medication use during pregnancy. In Study II, plasma samples from 200 women were obtained at gestational weeks 10-12 and 25, and screened for drugs. The results of the analysis were compared with medication use noted in antenatal medical care records. Study III was a national register‐based cohort study including 262,329 pregnant women, and their first child born in 2012-2015. Maternal obstetric and neonatal outcomes were studied in three groups: women diagnosed with depression and who had redeemed an antidepressant before becoming pregnant and women who were diagnosed with depression and who had redeemed an antidepressant both before and during pregnancy, were compared with each other and with women who had neither been diagnosed with depression nor been prescribed antidepressants. Study IV was a pharmacokinetic study that included 81 pregnant women with ongoing antidepressant medical treatment. Antidepressant drug and metabolite concentrations were measured throughout pregnancy. Participants were genotyped for enzymes involved in antidepressant drug metabolism, i.e. CYP2D6 and CYP2C19.  Results and conclusions: The majority of pregnant women in our study considered the use of medication during pregnancy as either “probably harmful” or “harmful”, and this perception was associated with non-use of medication. The women had high confidence in health care professionals when seeking advice about medication. There was a good coherence between reported drug intake in antenatal care records and presence of the drug in the pregnant women’s blood. For drugs prescribed for continuous use the coherence was 100%; thus, the reported use of medication in antenatal records is reliable. Women with major depressive disorder and antidepressant medication prior to becoming pregnant were at increased risk for adverse obstetric and neonatal outcomes compared with women without major depressive disorder. Continuation of antidepressant medication during pregnancy somewhat increased the risk of adverse obstetric and neonatal outcomes. The dose-adjusted concentrations of sertraline and citalopram and their metabolites, did not change significantly throughout pregnancy. Observed concentrations of escitalopram, mirtazapine and venlafaxine did not appear to change

Drug use in pregnant women-a pilot study of the coherence between reported use of drugs and presence of drugs in plasma

In Sweden, information on drug use during pregnancy is obtained through an interview and recorded in a standardized medical record at every visit to the antenatal care clinic throughout the pregnancy. Antenatal, delivery, and neonatal records constitute the basis for the Swedish Medical Birth Register (MBR). The purpose of this exploratory study was to investigate the reliability of reported drug use by simultaneous screening for drug substances in the blood stream of the pregnant woman and thereby validate self-reported data in the MBR. Plasma samples from 200 women were obtained at gestational weeks 10-12 and 25 and screened for drugs by using ultra-high performance liquid chromatography with time of flight mass spectrometry (UHPLC-TOF-MS). The results from the analysis were then compared to medical records. At the first sampling occasion, the drugs found by screening had been reported by 86% of the women and on the second sampling, 85.5%. Missed reported information was clearly associated with drugs for occasional use. The most common drugs in plasma taken in early and mid-pregnancy were meclizine and paracetamol. Two types of continuously used drugs, selective serotonin reuptake inhibitors and propranolol, were used. All women using them reported it and the drug screening revealed a 100% coherence. This study shows good coherence between reported drug intake and the drugs found in plasma samples, which in turn positively validates the MBR.Funding Agencies|Medical Research Council of Southeast Sweden [FORSS-385451]</p

The effect of variations of emotional expressions on mnemonic discrimination and traditional recognition memory

Face recognition occurs when a face is recognised despite changes between learning and test exposures. Yet there has been relatively little research on how variations in emotional expressions influence people’s ability to recognise these changes. We evaluated the ability to discriminate old and similar expressions of emotions (i.e. mnemonic discrimination) of the same face, as well as the discrimination ability between old and dissimilar (new) expressions of the same face, reflecting traditional discrimination. An emotional mnemonic discrimination task with morphed faces that were similar but not identical to the original face was used. Results showed greater mnemonic discrimination for learned neutral expressions that at test became slightly more fearful rather than happy. For traditional discrimination, there was greater accuracy for learned happy faces becoming fearful, rather than those changing from fearful-tohappy.These findings indicate that emotional expressions may have asymmetricalinfluences on mnemonic and traditional discrimination of the same face