RESUMO
Patients with epilepsy are at high risk for major depressive disorder (MDD) and, according to one report, postpartum depression (PPD) as well. The study described here sought to determine the prevalence and risk factors for PPD among women with epilepsy. Fifty-six women with epilepsy participating in a prospective study of perinatal antiepileptic drug (AED) pharmacokinetics were included. Participants completed the Beck Depression Inventory (BDI) during pregnancy and the postpartum period. Fourteen participants (25.0%) had a postnatal BDI score > or =12 indicative of PPD. Logistic regression indicated that significant risk factors for PPD among women with epilepsy included multiparity (odds ratio=12.5) and AED polytherapy (odds ratio=9.3). The rate of PPD was unaffected by the use of specific AEDs. In conclusion, PPD rates are higher among women with epilepsy than the general population, particularly those who are multiparous or receiving AED polytherapy, and there is no evidence that AED selection modifies this risk.
Assuntos
Anticonvulsivantes/uso terapêutico , Depressão Pós-Parto/tratamento farmacológico , Epilepsia/tratamento farmacológico , Adulto , Depressão Pós-Parto/epidemiologia , Epilepsia/classificação , Epilepsia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Razão de Chances , Gravidez , Prevalência , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Medição de Risco , Fatores de Risco , Adulto JovemRESUMO
To examine the extent and clinical sequelae of fetal exposure to zolpidem, a commonly prescribed hypnotic agent. Pregnant women with psychiatric illness participating in a study of psychotropic pharmacokinetics were included. Zolpidem concentrations were analyzed in maternal and umbilical cord plasma collected at delivery. Outcomes were compared between the zolpidem-exposed group and a 1:1 matched comparator group. Forty-five women taking zolpidem during pregnancy were studied. Rates of preterm delivery and low birth weight were 26.7% and 15.6% respectively in the zolpidem-exposed group versus 13.3% and 4.4% in the matched comparator group, but no significant differences were found. The ratio of umbilical cord to maternal plasma zolpidem concentrations in 6 pairs ranged from 0.48 to 2.75. Zolpidem crosses the human placenta and rapidly clears the fetal circulation. Pregnant women with psychiatric illness treated with zolpidem may have less optimal obstetrical outcome, though it is unclear if this was related to the medication.