Is uterine blood flow affected by psychotropics? (Biological Psychiatry: Sept 2012)

13.09.2012

Evidence suggests that maternal distress during pregnancy leads to decrements in children’s cognitive and psychosocial development, independent of maternal postnatal symptoms.SSRIs may contribute to poor perinatal outcomes and  and adverse offspring neurobehavioral development. atypical antidepressants and antipsychotics  have been associated with pregnancy complications.

Serotonin is a uterine vasoconstrictor. Dopamine is also likely to do the same.

Is it the maternal depression and anxiety that cause reductions in UBF ? Is that the pathway by which maternal distress is transduced to the fetes? UBF studies are not conclusive.

Researchers at  Emery University studied the UBF in a sample of second trimester pregnant women highly vulnerable to significant mood dysregulation. They   found no significant association between depression or anxiety and reductions in uterine or umbilical blood flow. SSRI s were also not associated with decrease in UBF.However, their report provides the first human evidence that bupropion use may be associated with a reduction in UBF.Bupropion is thought to aid in maintenance of physiologic arousal (i.e., in blood pressure, heart rate, plasma epinephrine and norepinephrine) and the haemodynamic effect may explain this effect.Chronic use of atypical antipsychotics and nicotine exposure also were associated with decreased UBF.

There was no objective verification of psychotropic medication use, and the study do not include data on women’s cardiovascular functioning.  Nearly 80% of the women in the study had normal uterine blood flows.

Practice Point : While prescribing psychotropics in pregnancy , strictly follow guidelines. Many psychotropics are associated with adverse effects on offsprings.  Record discussions with patient while prescribing.Medications including SSRIs are known to cause problems in the offspring.

Article:

Uterine blood flow in a psychiatric populationimpact of maternal depressionanxiety, and psychotropic medication.Monk C, Newport DJ, Korotkin JH, Long Q, Knight B, Stowe ZN. Biol Psychiatry. 2012 Sep 15;72(6):483-90. 

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