Antidepressants linked to heightened pregnancy related diabetes risk
Venlafaxine and amitriptyline and longer course of treatment associated with greatest risks
October 1, 2019
Science Daily/BMJ
Taking antidepressants while expecting a baby is linked to a heightened risk of developing diabetes that is specifically related to pregnancy, known as gestational diabetes, finds research published in the online journal BMJ Open.
The risk was greatest among mums to be who were taking venlafaxine, a type of drug known as a serotonin and norepinephrine reuptake inhibitor (SNRI), and amitriptyline, which belongs to an older class of antidepressant, known as tricyclics, the findings indicate.
Gestational diabetes affects up to one in five pregnant women worldwide. These pregnancies are prone to complications, such as overweight babies and prolonged labour due to the baby getting stuck in the birth canal.
The children of these pregnancies may also be more vulnerable to obesity and diabetes later on, while the mums are more likely to develop type 2 diabetes and cardiovascular disease.
Previous research looking at the potential link between antidepressant use and gestational diabetes risk has proved inconclusive and has been hampered by study design, say the researchers.
They drew on information from the Quebec Pregnancy Cohort, which incorporates three Canadian databases, and includes all pregnancies and children born in Quebec between 1998 and 2015.
Each case of gestational diabetes (20,905), identified after 20 weeks of pregnancy, was randomly matched with 10 unaffected pregnancies (209,050) of the same age and calendar year of delivery.
Antidepressant use was assessed using information on prescriptions filled for these drugs between the start of pregnancy and the diagnosis of gestational diabetes. In all, 9741 (just over 4%) of the mums took antidepressants, singly or combined.
These included citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline, which belong to a class of drugs known as selective serotonin reuptake inhibitors, or SSRIs for short; venlafaxine; and amitriptyline.
After taking account of potentially influential factors, such as the mum's age, welfare assistance, area of residence and other underlying conditions, taking antidepressants during pregnancy was associated with a heightened risk of developing gestational diabetes.
Taking any of these drugs was associated with a 19% heightened risk of being diagnosed with the condition compared with not taking antidepressants during pregnancy.
The risk was greatest for two antidepressant drugs, in particular: venlafaxine (27% heightened risk); and amitriptyline (52% heightened risk).
What's more, the risk increased, the longer certain types of antidepressants were taken, specifically SNRIs and tricyclics, singly or when combined.
Short term use was associated with a 15% heightened risk; medium term use was associated with a 17% heightened risk; and long term use with a 29% heightened risk.
When further analysis was done on a smaller group of women (21,395) who had been diagnosed with depression/anxiety before they became pregnant, the results were similar to those of the main analysis.
This is an observational study, and as such, can't establish cause. But there are some possible explanations for what they found, say the researchers.
This includes that antidepressants directly affect glucose metabolism, especially as serotonin is involved in this process. And one of the side effects of antidepressants is weight gain, a risk factor for diabetes.
But the pros and cons of taking antidepressants during pregnancy need to be weighed up carefully, caution the researchers, particularly for women whose depression is severe.
"The treatment of depression is a major concern and is challenging because depression is prevalent before and during pregnancy, and untreated depression can lead to relapse during pregnancy and in the [period immediately after birth]," they write.
https://www.sciencedaily.com/releases/2019/10/191001184927.htm
Sixty-four percent of women suffer from insomnia in late pregnancy
January 29, 2018
Science Daily/University of Granada
A new study warns that health systems need to address the problem of insomnia in pregnancy systematically, since as well as affecting the quality of life of pregnant women, insomnia is a risk factor for high blood pressure and pre-eclampsia, gestational diabetes mellitus, depression, preterm birth and unplanned caesarean sections.
The research study was recently published in the European Journal of Obstetrics & Gynecology and Reproductive Biology. 486 healthy pregnant women from Granada, Jaen, Huelva and Seville who had attended the Andalusian Health Service (SAS) before the 14th week of pregnancy (first trimester) participated in the study. The effects of pregnancy on these women were monitored throughout all three trimesters.
The results reveal that 44% of pregnant women suffer from insomnia in the first trimester of pregnancy, which increases to 46% in the second trimester and 64% in the third trimester. These are very high figures which, according to the authors of the research, justify the need for a "systematic approach to this problem."
Dr. María del Carmen Amezcua Prieto, one of the researchers behind the study and a lecturer at the Department of Preventive Medicine and Public Health of the University of Granada, explains that: "Although it is well known that pre-existing sleep problems worsen and new issues frequently arise during pregnancy, there is a tendency to assume that difficulties related to getting to sleep and maintaining restorative sleep are characteristic phenomena of pregnancy and that they must be endured."
However, Dr. Amezcua Prieto points out that: "This probably occurs because the health system does not give importance to the issue during the monitoring of pregnancies, to the point where the World Health Organization (WHO) does not even address the issue of sleep in its guidelines on providing care to pregnant women."
Insomnia-related problems
Insomnia causes numerous problems. It affects the quality of life of pregnant women, which apart from being of great importance per se, is also a risk factor for high blood pressure and pre-eclampsia, gestational diabetes, depression, premature birth and unplanned caesarean sections. Consequently, the issue must be tackled systematically.
María del Rosario Román Gálvez, one of the other researchers behind this ambitious project, warns that every single aspect of night-time sleep and its impact on daytime functioning must be addressed in order to study insomnia effectively.
"The results of our study show significant alterations in sleep fragmentation (the times women wake up during the night and how long they stay awake), as well as in daytime sleepiness. It also demonstrates that the frequency and intensity of sleep fragmentation continue to increase as the pregnancy progresses. Likewise, pregnancy also complicates sleep induction (the time it takes for an individual to fall asleep) and sleep duration. It is important to take into account these aspects to properly address the problem using non-pharmacological treatments," the UGR researcher notes.
Factors associated with insomnia were also analysed as part of the project. Prof. Aurora Bueno Cavanillas highlights that: "Although it may seem obvious, the most important factor is pre-gestational insomnia, given that it is fundamental to prevention and underscores the importance of detecting insomnia before pregnancy and throughout all stages of it." The study also revealed that other factors, such as obesity and whether or not the women have already had children, can have an impact on sleeping patterns.
Lastly, the study illustrates that the regular practice of moderate or intense physical exercise during pregnancy protects women against pregnancy-related insomnia, "so this is yet another reason for promoting physical activity during pregnancy."
https://www.sciencedaily.com/releases/2018/01/180129131340.htm
Obesity, diabetes in mom increases risk of autism in child
January 29, 2016
Science Daily/Johns Hopkins Bloomberg School of Public Health
Children born to obese women with diabetes are more than four times as likely to be diagnosed with autism spectrum disorder than children of healthy weight mothers without diabetes, new research suggests.
The findings, to be published Jan. 29 in the journal Pediatrics, highlight what has become a leading theory about autism, that the risk likely develops before the child is even born.
"We have long known that obesity and diabetes aren't good for mothers' own health," says study leader Xiaobin Wang, MD, ScD, MPH, the Zanvyl Krieger Professor in Child Health at the Bloomberg School and director of the Center on the Early Life Origins of Disease. "Now we have further evidence that these conditions also impact the long-term neural development of their children."
Autism spectrum disorder is a neurodevelopmental condition characterized by severe deficits in socialization, verbal and nonverbal communication and repetitive behaviors. Since the 1960s, the prevalence rates have skyrocketed, with one in 68 U.S. children now affected by it, according to the U.S. Centers for Disease Control and Prevention. Obesity and diabetes have also risen to epidemic levels in women of reproductive age over the same time period.
For the study, the researchers analyzed 2,734 mother-child pairs, a subset of the Boston Birth Cohort recruited at the Boston Medical Center at birth between 1998 and 2014. They collected data on maternal pre-pregnancy weight and whether the mothers had diabetes before getting pregnant or whether they developed gestational diabetes during pregnancy. They also followed up the children from birth through childhood via postnatal study visits and review of electronic medical records. They identified 102 children who were diagnosed with autism spectrum disorder over the course of the study. Those children with mothers who were both diabetic and obese were more than four times as likely to develop autism compared to children born to normal weight mothers without diabetes, they found.
"Our research highlights that the risk for autism begins in utero," says co-author M. Daniele Fallin, PhD, chair of the Bloomberg School's Department of Mental Health and director of the Wendy Klag Center for Autism and Developmental Disabilities. "It's important for us to now try to figure out what is it about the combination of obesity and diabetes that is potentially contributing to sub-optimal fetal health."
Previous studies had suggested a link between maternal diabetes and autism, but this is believed to be the first to look at obesity and diabetes in tandem as potential risk factors.
Along with pre-conception diabetes, children of obese mothers who developed gestational diabetes during pregnancy were also at a significantly higher risk of being diagnosed with autism.
The biology of why obesity and diabetes may contribute to autism risk isn't well understood. Obesity and diabetes in general cause stress on the human body, the researchers say. Previous research suggests maternal obesity may be associated with an inflammation in the developing fetal brain. Other studies suggest obese women have less folate, a B-vitamin vital for human development and health.
The researchers say that women of reproductive age who are thinking about having children need to not only think about their obesity and diabetes status for their own health, but because of the implications it could have on their children. Better diabetes and weight management could have lifelong impacts on mother and child, they say.
"In order to prevent autism, we may need to consider not only pregnancy, but also pre-pregnancy health," Fallin says.
http://www.sciencedaily.com/releases/2016/01/160129091631.htm
History of depression puts women at risk for diabetes during pregnancy
March 31, 2015
Science Daily/Loyola University Health System
A history of depression may put women at risk for developing diabetes during pregnancy, according to research. This study also pointed to how common depression is during pregnancy and the need for screening and education.
"Women with a history of depression should be aware of their risk for gestational diabetes during pregnancy and raise the issue with their doctor," said Mary Byrn, PhD, RN, study co-author and assistant professor, MNSON. "Health-care providers also should know and understand the prevalence and symptoms of prenatal depression and gestational diabetes and screen and manage these women appropriately."
Loyola researchers used the Edinburgh Postnatal Depression Screen to measure symptoms of depression in 135 pregnant women attending routine prenatal care visits. Sixty-five study participants had gestational diabetes. These women were 3.79 times more likely to have a history of depression than women without gestational diabetes. In addition, 20 percent of women with gestational diabetes and 13 percent of women without gestational diabetes had significant symptoms of depression. Anxiety and perceived stress were significant predictive factors of depression for both groups.
Each year, more than 200,000 pregnancies are complicated by gestational diabetes. Pregnant women who have gestational diabetes and the added issue of depression are at an even greater risk for possible negative outcomes. Pregnant women who are depressed are more likely to practice unhealthy behaviors such as smoking, alcohol use and missing prenatal doctor visits.
The relationship between diabetes and depression is complex. Clinicians initially believed that depression in people with diabetes was due to the demands of living with a chronic illness. More contemporary thinking suggests that having depression may precipitate the onset of type 2 diabetes. Therefore, if depression is present prior to pregnancy, it may be important to monitor for the development of gestational diabetes.
"Depression may also contribute to the poor self-management of gestational diabetes and potentially increase the chance for complications during pregnancy," said Sue Penckofer, PhD, RN, study co-author and professor, MNSON. "We must further explore the relationship between diabetes and depression to help understand and improve prenatal care and outcomes for women and infants."
http://www.sciencedaily.com/releases/2015/03/150331121245.htm
Depression in early pregnancy linked to gestational diabetes
September 19, 2016
Science Daily/National Institutes of Health
A two-way link between depression and gestational diabetes has been uncovered by researchers. Women who reported feeling depressed during the first two trimesters of pregnancy were nearly twice as likely to develop gestational diabetes, according to an analysis of pregnancy records. Conversely, a separate analysis found that women who developed gestational diabetes were more likely to report postpartum depression six weeks after giving birth, compared to a similar group of women who did not develop gestational diabetes.
https://images.sciencedaily.com/2016/09/160919094450_1_540x360.jpg
Pregnant woman having her blood sugar/ glucose checked.
Credit: © Mediteraneo / Fotolia
Gestational diabetes is a form of diabetes (high blood sugar level) occurring only in pregnancy, which if untreated may cause serious health problems for mother and infant.
"Our data suggest that depression and gestational diabetes may occur together," said the study's first author, Stefanie Hinkle, Ph.D., staff scientist in the Division of Intramural Population Health Research at the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Until we learn more, physicians may want to consider observing pregnant women with depressive symptoms for signs of gestational diabetes. They also may want to monitor women who have had gestational diabetes for signs of postpartum depression."
Although obesity is known to increase the risk for gestational diabetes, the likelihood of gestational diabetes was higher for non-obese women reporting depression than for obese women with depression.
The researchers analyzed pregnancy records from the NICHD Fetal Growth Studies-Singleton Cohort, which tracked the progress of thousands of pregnancies, to understand the patterns of fetal growth. The study enrolled 2,334 non-obese and 468 obese women in weeks eight to 13 of pregnancy. The women responded to questionnaires on symptoms of depression when they enrolled in the study, again between the 16th and 22nd week of pregnancy, and then six weeks after giving birth. The researchers also reviewed the women's records to identify who had developed gestational diabetes.
"Of particular note, persistent depression from the first to second trimester set women at even greater risk for gestational diabetes" said the study's senior author, Cuilin Zhang, M.D., Ph.D, in the Division of Intramural Population Health Research at NICHD. Women who had the highest scores for depression in the first and second trimesters -- about 17 percent -- had nearly triple the risk for gestational diabetes when compared to women who had lower depression scores.
"Our results suggest it would be a good idea for clinicians to pay particular attention to women with high depression scores when evaluating the risk of gestational diabetes," Dr. Zhang added.
Although obesity increases the risk for gestational diabetes, non-obese women with high depression scores had nearly triple the risk for gestational diabetes than the other women in the study. Depression did not appear to increase the risk for gestational diabetes among obese women.
Currently, the American College of Obstetricians and Gynecologists recommends (link is external) that physicians screen patients at least once for depression during the perinatal period (link is external) (22 weeks of pregnancy through 7 days after birth.)
The researchers also found a higher risk for postpartum depression among the women who had gestational diabetes. Of the women who developed gestational diabetes, nearly 15 percent experienced depressive symptoms after birth, which was more than four times that of women who had not had gestational diabetes.
Dr. Hinkle stressed that the study was not able to prove a cause and effect relationship between symptoms of depression and gestational diabetes. The researchers added that earlier studies have shown that depression is associated with impaired glucose metabolism that may lead to higher blood sugar levels. Similarly, high blood sugar levels may lead to inflammation, hormonal, and other changes that could lead to symptoms of depression.Gestational diabetes is a form of diabetes (high blood sugar level) occurring only in pregnancy, which if untreated may cause serious health problems for mother and infant.
"Our data suggest that depression and gestational diabetes may occur together," said the study's first author, Stefanie Hinkle, Ph.D., staff scientist in the Division of Intramural Population Health Research at the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "Until we learn more, physicians may want to consider observing pregnant women with depressive symptoms for signs of gestational diabetes. They also may want to monitor women who have had gestational diabetes for signs of postpartum depression."
Although obesity is known to increase the risk for gestational diabetes, the likelihood of gestational diabetes was higher for non-obese women reporting depression than for obese women with depression.
The researchers analyzed pregnancy records from the NICHD Fetal Growth Studies-Singleton Cohort, which tracked the progress of thousands of pregnancies, to understand the patterns of fetal growth. The study enrolled 2,334 non-obese and 468 obese women in weeks eight to 13 of pregnancy. The women responded to questionnaires on symptoms of depression when they enrolled in the study, again between the 16th and 22nd week of pregnancy, and then six weeks after giving birth. The researchers also reviewed the women's records to identify who had developed gestational diabetes.
"Of particular note, persistent depression from the first to second trimester set women at even greater risk for gestational diabetes" said the study's senior author, Cuilin Zhang, M.D., Ph.D, in the Division of Intramural Population Health Research at NICHD. Women who had the highest scores for depression in the first and second trimesters -- about 17 percent -- had nearly triple the risk for gestational diabetes when compared to women who had lower depression scores.
"Our results suggest it would be a good idea for clinicians to pay particular attention to women with high depression scores when evaluating the risk of gestational diabetes," Dr. Zhang added.
Although obesity increases the risk for gestational diabetes, non-obese women with high depression scores had nearly triple the risk for gestational diabetes than the other women in the study. Depression did not appear to increase the risk for gestational diabetes among obese women.
Currently, the American College of Obstetricians and Gynecologists recommends (link is external) that physicians screen patients at least once for depression during the perinatal period (link is external) (22 weeks of pregnancy through 7 days after birth.)
The researchers also found a higher risk for postpartum depression among the women who had gestational diabetes. Of the women who developed gestational diabetes, nearly 15 percent experienced depressive symptoms after birth, which was more than four times that of women who had not had gestational diabetes.
Dr. Hinkle stressed that the study was not able to prove a cause and effect relationship between symptoms of depression and gestational diabetes. The researchers added that earlier studies have shown that depression is associated with impaired glucose metabolism that may lead to higher blood sugar levels. Similarly, high blood sugar levels may lead to inflammation, hormonal, and other changes that could lead to symptoms of depression.
Science Daily/SOURCE :https://www.sciencedaily.com/releases/2016/09/160919094450.htm