Mirtazapine in pregnancy and lactation: data from a case series.

Depression is a common disorder in pregnancy and associated with adverse effects for both mother and neonate. Pharmacological treatment and prevention options include mirtazapine. In a series of 56 cases, we investigated neonatal outcome after intrauterine exposure to mirtazapine and exposure through lactation in the first days postpartum.No increase in any neonatal complication was observed. None of the infants exposed to mirtazapine in the first trimester were born with a major malformation. Of the 54 infants exposed to mirtazapine in the third trimester, 14 were diagnosed with poor neonatal adaptation syndrome (PNAS). This incidence (25.9%) is similar to the incidence of PNAS after intrauterine exposure to other antidepressants. The incidence of PNAS after exposure to mirtazapine was significantly diminished in children who were partially or fully breastfed (18.6% versus 54.5%, P = 0.024).

Mirtazapine in pregnancy and lactation - A systematic review.

Depression is common in pregnancy and associated with increased risk of adverse effects for the neonate. Treatment and prevention options include antidepressant therapy. The aim of this paper was to review the literature on safety of mirtazapine during pregnancy and lactation. In 31 papers a total of 390 cases of neonates exposed to mirtazapine during pregnancy or lactation have been described. There might be an association between mirtazapine and spontaneous abortion, however, this might be attributable to underlying psychiatric disease. An increased risk of major neonatal malformations associated with mirtazapine in pregnancy has not been reported. Although one study showed a nearly significant increase in occurrence of respiratory problems and hypoglycaemia, no indication of causality could be given. No other significant adverse effects on neonates were reported. Limited available data, four papers on 11 exposed neonates, suggest that use of mirtazapine during breastfeeding is safe due to a low relative infant dose. High plasma levels might be associated with increased body weight and sleep. However, the reported data are too scarce to come to a clear assessment of the risk of mirtazapine in lactation. No information is available on the use of mirtazapine in pregnancy and Poor Neonatal Adaptation Syndrome (PNAS) or neurobehavioral development at an age over one year. In conclusion, mirtazapine seems to be safe in pregnancy, especially regarding incidence of congenital malformations. There are not enough data available to come to a conclusion on the safety of mirtazapine during lactation.

[Pregnant women with psychiatric illness are able to stop smoking]. / Zwangere met psychiatrische stoornis kan stoppen met roken.

Smoking during pregnancy is associated with neonatal complications and health problems later in life. However, about 10% of the pregnant women in the Netherlands smoke and those with a psychiatric illness smoke even more frequently. Although giving up smoking may be more difficult for these women, it does not lead to an increase of psychiatric symptoms. We present two patients who smoked during pregnancy. A 28-year-old female started smoking again during her first pregnancy when her depression relapsed. We advised a higher dose of medication and with her midwife's support she gave up smoking. A 35-year-old female, suffering from posttraumatic stress disorder, had an increase of symptoms during her second pregnancy. She resumed smoking to feel more relaxed. Treatment with bupropion and an online support program helped her to give up smoking. We advise that every smoking pregnant woman with psychiatric problems be treated concurrently for the psychiatric illness and for smoking.