depression/anxiety during preg, & preg htn disorders

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caryn
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Re: depression/anxiety during preg, & preg htn disorders

Postby caryn » Sat Jan 24, 2015 09:17 pm

Let's send that up to the Experts. This is a really grey area where individuals need to weigh risks and benefits.

My reading of the data at this point suggests antidepressant use raises risk, but only a tiny bit - the odds ratio goes from 1.52 from 1.00 if you switch from SNRI to SSRI, for example: http://www.ncbi.nlm.nih.gov/pubmed/23873072 That's moving from a 5% risk to a 7.5% risk in your first pregnancy (subsequent pregnancies will be a different problem) of developing preeclampsia *of some degree of severity at some point in the pregnancy or postpartum period*.

Generally speaking, if you drive a car, you're putting your kids at way more risk. And since the risk of preeclampsia is higher if you're a depressive *before* pregnancy, odds are we're picking up a population-level characteristic: people who carry the genes that predispose them to develop depression or anxiety in certain environmental conditions also carry the genes that predispose them to develop preeclampsia. If the medication is working, it carries substantial benefits. So definitely a case where individuals want to talk through the risks and benefits with their care providers.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
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Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy

laney_p
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Re: depression/anxiety during preg, & preg htn disorders

Postby laney_p » Thu Jan 22, 2015 07:05 pm

Hey Caryn,

This leads very nicely to a question that I got posed via Facebook by one of our supporters related to this area of anxiety and preeclampsia. After having a traumatic pregnancy experience in the first go-round, she was put on anti-anxiety medications (specifically, a Type-B drug buspirone). She wants to get pregnant again, but is hesitant about being on the medication for the baby's sake, but also being off it for the sake of herself and sanity. (For anonymity sake, not posting anything else here.)

Any research to which I could point her? Or would it be possible to post to the experts@ section to get their feedback for her? With the increased attention around PTSD and postpartum depression/anxiety after preeclampsia, I think this is probably going to become a more frequent question from patients about their self-care.
Director of Community Relations for the Preeclampsia Foundation
*does not provide any medical advice*
for more information, please visit www.preeclampsia.org

La Directora de las Relaciones con la Comunidad
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alviarin
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Re: depression/anxiety during preg, & preg htn disorders

Postby alviarin » Wed Jan 21, 2015 02:23 am

I still wonder if thyroid issues could be involved since they are so common. Mood disorders are higher in those with thyroid issues, and even "subclinical" hypothyroidism may raise risk of preeclampsia.
Sadly I've known women who have been offered Wellbutrin or Prozac when all they really needed was adequate thyroid diagnosis and treatment.
Hypothyroid mom to
Connor (severe pre-e at 38 weeks)
Claire (dx'd with pre-e and induction at 37 weeks)
Annabelle (chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)

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caryn
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depression/anxiety during preg, & preg htn disorders

Postby caryn » Tue Jan 20, 2015 11:20 pm

"Our results suggest that the link between maternal chronic hypertension and depression/anxiety symptoms precedes pregnancy. In addition, prepregnancy history of depression/anxiety symptoms may be considered part of a risk profile for preterm preeclampsia."

http://www.ncbi.nlm.nih.gov/pubmed/25588112

So, this suggests that if you're someone who has a history of depression or anxiety, you're at higher risk to develop preeclampsia in your first pregnancy. Women with those conditions were more likely to develop preeclampsia, especially early preeclampsia, than women who did not have them.
Science! The articles you don't want to miss:
The Preeclampsia Puzzle (New Yorker) and Silent Struggle: A New Theory of Pregnancy (New York Times)
Looking for recent articles and studies?
A chance to participate in research? For us on Facebook or Twitter?

Caryn, @carynjrogers, who is not a doctor and who talks about science stuff *way* too much
DS Oscar born by emergent C-section at 34 weeks for fetal indicators, due to severe PE
DD Bridget born by C-section after water broke at 39 weeks after a healthy pregnancy


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