Neonatal outcomes after gamma-aminobutyric acid analog use during pregnancy: a meta-analysis of cohort studies.

BACKGROUND: Gamma-aminobutyric acid (GABA) analogs are being used by an increasing number of reproductive-age women. However, there is concern regarding the teratogenic potential of GABA analogs. METHODS: We performed this systematic review and meta-analysis to assess the relationship between GABA analog exposure and risk of adverse neonatal outcomes. RESULTS: Eight cohort studies were included in the meta-analysis. Exposure to a GABA analog during pregnancy was not associated with an increased risk of congenital malformation (odds ratio [OR] 1.19, 95% confidence interval [CI] 0.96-1.46, P = 0.106) or a small for gestational age (SGA) infant (OR 1.99, 95% CI 0.78-5.1, P = 0.152) compared to no exposure. However, exposure to a GABA analog was associated with an increased risk of preterm birth (PB) (OR 1.56, 95% CI 1.04-2.35, P = 0.033), spontaneous abortion (SA) (OR 1.64, 95% CI 1.14-2.38, P = 0.008), or termination of pregnancy (TOP) (OR 3.02, 95% CI 2-4.56, P < 0.001). CONCLUSION: Exposure to GABA analogs during pregnancy does not appear to be associated with congenital malformation, although there was some evidence of a higher risk of several other negative neonatal outcomes. Given the few studies included, larger prospective studies controlling for important confounders are needed to verify our findings.

Important Role of Estrogen in Distinguishing Depression and Schizophrenia and Prognostic Judgment of MECT.

OBJECTIVES: This study aimed to investigate the role of estrogen in the differential diagnosis of depression and schizophrenia and its relationship with the curative effects, adverse events. METHODS: From 2017 to 2019, patients with depression or schizophrenia treated with modern electroconvulsive therapy (MECT) were studied retrospectively. Their serum estrogen levels, Hamilton Depression Scale, and Brief Psychiatric Rating Scale scores were collected. Differences in the estrogen levels between patients with depression and schizophrenia before and after treatment and the correlation of the estrogen level with curative effect and adverse events was evaluated. In total, 67 patients with depression and 61 with schizophrenia were included. RESULTS: There were no significant differences in the baseline characteristics, except the estrogen level (p < 0.001). Serum estrogen levels increased in both groups after MECT (117 vs. 141 pmol/L, p < 0.001; 42 vs. 46 pmol/L, respectively; p < 0.001), and higher estrogen levels were positively correlated with better outcomes (p < 0.001). CONCLUSION: Post-MECT estrogen levels were not associated with the incidence rate of adverse events of MECT. Estrogen plays a promising role in distinguishing depression and schizophrenia and evaluating the therapeutic efficacy of MECT.

Long-term Effectiveness of Modified Electroconvulsive Therapy Compared With Repetitive Transcranial Magnetic Stimulation for the Treatment of Recurrent Major Depressive Disorder.

This retrospective study recruited 150 patients with recurrent major depressive disorder (MDD) who received modified electroconvulsive therapy (MECT) and 150 cases treated with repetitive transcranial magnetic stimulation (rTMS), which aimed to compare the short- and long-term effectiveness, as well as economic outcomes, of MECT and rTMS with a large sample size in patients with recurrent MDD. The results showed that the response rate of patients in the rTMS group was lower than that in the MECT group (46.0% vs 58.7%, p < 0.05). Patients in the rTMS group had elevated rate of dizziness, but reduced rates of poor memory and headache, as well as lower costs compared with the MECT group (p < 0.05). Importantly, we found that the relapse-free survival of patients was similar between the rTMS and MECT groups in the long term. In conclusion, rTMS is an alternative method for MECT in the treatment of patients with recurrent MDD.