Browsing by Author "Marks, Claire"

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    Comparing Newborn Outcomes After Prenatal Exposure to Individual Antidepressants: a retrospective cohort study
    (Wiley, 2021) Marks, Claire; Silvola, Rebecca; Teal, Evgennia; Quinney, Sara K,; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Objective: To compare associations between individual antidepressants and newborn outcomes. Design: Retrospective cohort study. Setting: Deliveries in a large, US medical system. Population: Women who received at least one antidepressant prescription 3 months prior to conception through delivery. Methods: Eligible women had maternal characteristics and newborn outcomes extracted from medical record data. Exposure was defined by the timing of the prescription during pregnancy. Main outcome measures: Newborn outcomes (any adaptation syndrome, neonatal intensive care unit (NICU) admission) were analyzed for each antidepressant and compared using standard statistics and multivariable regression compared to exposure to bupropion. Odds of outcomes based on timing of exposure were also explored. Results: A total of 3,694 women were analyzed. Rates of any adaptation syndrome (p < 0.001), NICU admission (p < 0.001), and transient tachypnea of newborn (TTN) (p = 0.006) were significantly different between drugs. Infants exposed to duloxetine had the highest rates of NICU admissions (39.6%) and adaptation syndromes (15.1%). Venlafaxine-exposed infants had the highest rates of TTN (18.2%). Controlling for maternal age, race, insurance, and gestational age at delivery, early pregnancy antidepressant exposure was associated with adaptation syndrome and NICU admission for both duloxetine (adjusted odds ratio (aOR) 2.31 [95% Confidence Interval (CI) 1.11-4.80] and aOR 2.47 [95% CI 1.40-4.34], respectively) and escitalopram (aOR 1.72 [95% CI 1.09-2.70] and aOR 1.64 [95% CI 1.21-2.22], respectively). Exposure in the third trimester was associated with any adaptation syndrome for citalopram, duloxetine, escitalopram, fluoxetine, sertraline, and venlafaxine and NICU admission for bupropion, citalopram, duloxetine, escitalopram, and fluoxetine. Conclusion: Duloxetine and escitalopram appear to have the strongest associations with any adaptation syndrome and NICU admission whereas bupropion and sertraline tended to have among the lowest risks of these outcomes. These results can help providers and patients discuss choice of individual antidepressant drugs during pregnancy.
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    Does lack of exposure to individual antidepressants at different points during pregnancy associate with reduced risk of adverse newborn outcomes?
    (BMC, 2022-12-09) Tharp, Margaret A.; Silvola, Rebecca M.; Marks, Claire; Teal, Evgennia; Quinney, Sara K.; Haas, David M.; Obstetrics and Gynecology, School of Medicine
    Background: The objective of this study was to determine if the lack of exposure to individual antidepressants at certain times in pregnancy improved maternal and infant outcomes. Methods: This was a retrospective cohort study of 2741 pregnant women prescribed antidepressant(s) before or during pregnancy. Data were obtained from electronic medical records. Analysis was limited to women prescribed one of five antidepressants (bupropion, citalopram, escitalopram, fluoxetine, sertraline). Period of exposure was determined using prescription order dates. Primary outcomes were neonatal intensive care unit (NICU) admission and adaptation syndrome in the newborn. Logistic regression, adjusted for maternal age, race, and insurance, compared consistent exposure throughout pregnancy versus (A) no exposure in the third trimester, (B) no exposure early in pregnancy, and (C) exposure in the midtrimester alone. Results: Compared to women prescribed an antidepressant continually throughout pregnancy, NICU admission was less likely for women lacking exposure in the third trimester if they had been taking bupropion (aOR 0.43, 95% CI 0.21-0.90) or escitalopram (aOR 0.49, 95% CI 0.28-0.85). Women previously taking escitalopram but lacking third trimester exposure also had lower odds of adaptation syndrome (aOR 0.19, 95% CI 0.07-0.48). No differences were found in other outcomes for women taking other antidepressants or for any outcomes for women who lacked early pregnancy drug exposure compared to exposure throughout pregnancy. Conclusion: For the five antidepressants included in this study, lack of exposure early or late in pregnancy compared to consistent exposure throughout pregnancy generally did not change newborn outcomes. The exceptions were bupropion and escitalopram, where lack of exposure in the third trimester associated with lower rates of adaptation syndrome or NICU admission. These data may help pregnant women with depression in need of drug therapy to have informed discussions with providers about the potential risks and benefits to continuing or stopping drugs at different times during pregnancy.
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    The Heart of Maternal Mortality: Postpartum Cardiomyopathy and Its Upstream Determinants of Health
    (2020) Campbell, Meredith; Lee, Deborah; Marks, Claire; Palma, Samantha; Yang, Caroline
    CASE: A 25-year-old obese African American female presented with dyspnea 6 weeks after a full-term vaginal delivery complicated by pre-eclampsia. Further work up showed LV enlargement without hypertrophy and globally decreased contractility consistent with postpartum cardiomyopathy as well as endocarditis with vegetations on the aortic and tricuspid valves. In the setting of poor patient compliance, patient progressed to worsening systolic heart failure as LVEF dropped from 45% to 25% within a year. Despite further management including valve replacement, ICD placement and a continuous milrinone treatment, LVEF continued to decline, with the lowest value at 12%. During one of her recurrent acute respiratory failures, the patient and team made the difficult decision to transition to palliative care, where she expired. BACKGROUND: Postpartum cardiomyopathy (PPCM) is a life-threatening disease that arises between the last month of pregnancy and four months after delivery, where patients present with dyspnea, dizziness, or lower extremity edema. Although it is rare with an incidence of 1 case per 2187 live births, it has a high mortality rate in the US ranging from 6% to 10%, mostly in the first 30 days. DISCUSSION: Multiple recent studies have demonstrated the significance of early diagnosis of PPCM and its strong association with more favorable outcomes, including greater LVEF recovery and lower rates of morbidity and mortality. This evidence suggests the need for pre-discharge screening, in order to diagnose patients earlier and give them the greatest opportunity for a full recovery. Additionally, patient noncompliance, largely influenced by socioeconomic status and medical literacy of the patient, is another crucial factor that affects the prognosis of PPCM. Effective strategies to increase compliance include educating the patient, using an inter-professional healthcare team, and working with the psychological and socioeconomic barriers to compliance.