Taking Certain Antidepressants During Pregnancy ‘Raises Risks’ Of Babies Suffering Birth Defects

Antidepressants such as paroxetine or Prozac taken during pregnancy have been associated with an increased risk of birth defects.

Researchers in the United States focused bracelets on selective serotonin reuptake inhibitor (SSRI) antidepressants, which they said are increasingly being used by women of reproductive age and during pregnancy.

They analysed women who took citalopram, escitalopram, fluoxetine (Prozac), paroxetine or sertraline at least once between the month leading up to conception and the third month of pregnancy.

The team said that while they found “reassuring evidence” for some SSRIs, some birthdefects were up to three and a half times more likely to occur in babies whose mothers took paroxetine or fluoxetine.

But they said that the absolute risks for these birth defects still remains low.

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The research, which is published in the British Medical Journal, analysed 18,000mothers of infants with birth defects and 10,000 mothers of infants without birth defects, born in the US between 1997 and 2009.

A number of specific birth defects have been described in previous studies of women taking SSRIs, and these were analysed further in this latest research, which was led by the National Center on Birth Defects replica cartier and Developmental Disabilities in Atlanta, Georgia.

The birth defects were defined in the US National Birth Defects Prevention Study (NBDPS), which includes more than 30 categories of major birth defects.

Sertraline was the most commonly used SSRI, with around 40% of the women taking it, but none of the five previously reported associations between sertraline and birth defects were found.

They said that for nine other previously reported associations between maternal SSRI use and birth defects in infants, they also found no links.

But they said two previously reported birth defects associated with fluoxetine treatment were observed – heart wall defects and irregular skull shape (craniosynostosis).

Five previously reported birth defects associated with paroxetine treatment were also seen, including heart defects, problems with brain and skull formation (anencephaly), and abdominal wall defects.

But the researchers said the absolute risks in the babies of women who are treated with paroxetine early in pregnancy would increase for anencephaly from two per 10,000 to seven per 10,000, and for one of the heart defects from 10 per 10,000 to 24 per 10,000.

“Although our analysis strongly supports the validity of the associations that were observed, the increase in the absolute risks, if the associations are causal, is small,” they said.

“Continued scrutiny of the association between SSRIs and birth defects is warranted, and additional studies of specific SSRI treatments during pregnancy and birth defects are needed to enable women and their healthcare providers to make more informed decisions about treatment.”

Dr Michael Bloomfield, a clinical lecturer in psychiatry at University College London, said that doctors in the UK generally prescribe lower doses of psychiatric medicines to patients than in the US and warned that no one should stop taking treatment without talking to their doctor first.

He added: “It has been known that for some time that there is a small increase in the risk of birth defects when women take these medicines in pregnancy, although some of these medicines appear to be safer than others.

“Whilst common, depression can be a potentially life-threatening illness. Any decision around treatment in pregnancy needs to weigh up the potential small risks of birth defects against the benefits of treatments including helping a mother cartier bracelet price get better from depression.

“In addition, there is evidence to suggest that a baby whose mother had depression during pregnancy may be more likely to have mental illnesses themselves during later life.

“Any woman who is either pregnant or planning to become pregnant and needs to take a serotonin reuptake inhibitor should discuss her treatment with her GP or psychiatrist.

“It may be that they advise switching to a different serotonin reuptake inhibitor that appears to be safer.

No one should stop taking a serotonin reuptake inhibitor without first discussing this with their doctor.”

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http://www.huffingtonpost.co.uk/2015/07/08/antidepressants-birth-defect-link_n_7758166.html

Study Offers New Insights Into AED/Autism Risk For Pregnant Women

Ultrasound scan of foetus

A new Australian study has provided clearer insights into the link between the use of antiepileptic drugs (AEDs) in pregnant women and the elevated risk of autism in their unborn children.

Conducted in partnership between the University of Birmingham and a number of Australian institutions, the prospective cohort study examined 105 children exposed to anticonvulsants during pregnancy in order to gain a better understanding of the true risks involved.

Each of the children were aged between six and eight years old and were recruited via the Australian Pregnancy Register for Women on Antiepileptic Medication. Maternal epilepsy, pregnancy and medical history data were obtained prospectively, while autism traits were assessed using the Childhood Autism Rating Scale (CARS).Watch movie online Get Out (2017)

According to results published in the medical journal Epilepsia, 11 children – or 10.5 per cent of the cohort – had elevated CARS scores, enough to indicate an increased rate of autism traits across the sample.

The most important determinant of association with autistic traits was higher doses of sodium valproate exposure – of the 11 patients affected, two had been exposed to valproate monotherapy, two to carbamazepine monotherapy and seven to valproate in polytherapy.

Linear regression analysis showed that the mean valproate dose during pregnancy was a significant predictor of CARS scores after controlling for polytherapy, mean carbamazepine dose, folic acid use, seizures during pregnancy, tobacco and marijuana use, maternal IQ and socioeconomic status.

First trimester folic acid supplementation and marijuana use were also significant predictors of CARS scores.

Additionally, the paper highlighted one potential way in which valproate could be incorporated into maternal epilepsy treatment in a less risky manner.

The researchers said: “The use of valproate in women who may become pregnant is now generally avoided; however, there is insufficient data regarding the risk of ASD with low-dose valproate.

“If this risk is no greater than with other AEDs, it may enable women with genetic generalised epilepsy to retain optimal seizure control, as well as minimise harm to their unborn child.”

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Common antibiotic taken in pregnancy may double the risk of epilepsy or cerebral palsy in babies

  • Erythromycin is an antibiotic given for urinary and chest infections
  • Is prescribed during recurrent illness or for people allergic to penicillin
  • Researchers called for a safety review but stressed increased risk is small 
  • Overall, study found antibiotics taken during pregnancy were safe

Women have been warned that a common antibiotic could harm their unborn baby.

A study from Great Ormond Street Hospital (GOSH) has linked erythromycin pills with epilepsy and the cerebral palsy.

The researchers stressed that any increased risk is small. However, they are concerned enough to call for a thorough safety review.

Others said it is important to note that the majority of antibiotics prescribed in pregnancy were given a clean bill of health.

Woman have been warned the common antibiotic erythromycin could harm their unborn baby (file photo)

Woman have been warned the common antibiotic erythromycin could harm their unborn baby (file photo)

The researchers from GOSH and University College London tracked the brain health of the babies born to almost 200,000 British women

Around a third were prescribed antibiotics, with penicillin the most common.

Overall, the babies born to women who took antibiotics were no more likely to develop epilepsy or cerebral palsy than others.

However, one particular type of antibiotic did raise concern.

Women treated with erythromycin and other pills from the macrolide family of antibiotics were almost twice as likely to have a baby with one of the brain conditions than those given penicillin.

Macrolides are used to treat urinary and chest infections and are particularly likely to be given during recurrent illness or if a woman is allergic to penicillin.

Researcher Professor Ruth Gilbert said that just 7 per cent of those given antibiotics had taken macrolides and that any increased risk to the unborn child is small.

Her figures show that every 150 or so pregnant women given a macrolide antibiotic rather than penicillin, there will be one more baby born with cerebral palsy or epilepsy.

WHAT IS ERYTHROMYCIN?

Erythromycin are from the macrolide family of antibiotics.

Macrolides are used to treat urinary and chest infections and are particularly likely to be given during recurrent illness or if a woman is allergic to penicillin.

However, with four previous studies raising concerns about the pills, it is time that their use in pregnancy was thoroughly reviewed by the Medicines and Healthcare Products Regulatory Agency.

In the meantime, she advises pregnant women to take whichever antibiotics they are prescribed.

She said that the infection itself is more likely to be harmful to the unborn child than the treatment.

Professor Andrew Whitelaw, of Bristol University, said that bad infections can kill both mother and child.

But ‘nevertheless, drug treatment in pregnancy requires a very high level of safety and it will not surprise me if the regulatory authorities advise doctors to avoid or severely restrict macrolides in pregnancy’.

Others said that the study does not prove that macrolides are harmful.

Erythromycin is used to treat urinary and chest infections and are particularly likely to be given during recurrent illness or if a woman is allergic to penicillin

Erythromycin is used to treat urinary and chest infections and are particularly likely to be given during recurrent illness or if a woman is allergic to penicillin

One possibility is that the bugs they used treat are more likely to damage the brain than other infections.

Dr Christoph Lees, of University College London, said: ‘One thing is for sure: pregnant women should definitely take antibiotics when prescribed them as the risk of untreated infection to the pregnancy can be catastrophic.

‘To put things in context, the extra risk to their baby of being prescribed macrolides, if indeed there is a risk, is very tiny.’

The medicines’ watchdog, the MHRA, said it has already sought independent advice on the GOSH study and it does not provide proper proof that macrolides are dangerous.

A spokesman said: ‘Importantly, this study found no overall evidence of harm when antibiotics are prescribed in pregnancy.

‘Any pregnant woman who is prescribed antibiotics should continue to take them as instructed and speak to their healthcare professional if they have any questions.’

The study is published in the journal PLOS ONE.

Read more: http://www.dailymail.co.uk/health/article-3011324/Common-antibiotic-taken-pregnancy-double-risk-epilepsy-cerebral-palsy-babies.html#ixzz3VRX8WnB6Watch movie online The Transporter Refueled (2015)

Pregnant woman was killed by train after doctor ‘failed to warn her an anxiety drug could cause suicidal feelings’

  • Pregnant Joanne Norris walked in front of speeding train at Witham, Essex
  • 28-year-old and her unborn baby were killed in incident in March last year
  • Inquest heard how Mrs Norris had suffered severe anxiety since age of 17
  • She took medication to manage anxiety but stopped when she fell pregnant
  • Later put back on low dosage by GP who ‘failed to warn her of side effects’
  • GP said he didn’t warn her as it was low dose and she had taken it before
  • Coroner said opportunities were missed to help her in lead up to her death 
Joanne Norris, 28, mother to three-year-old Lily (together above) and her unborn baby died after she walked in front of a train at Witham Station, Essex

Joanne Norris, 28, mother to three-year-old Lily (together above) and her unborn baby died after she walked in front of a train at Witham Station, Essex

A pregnant woman killed herself by walking into the path of a train after a doctor failed to warn her about the side-effects of an anti-anxiety drug, an inquest heard.

Joanne Norris, 28, and her unborn baby died after she walked into the path of a speeding train at Witham station, Essex, on March 16 last year.

An inquest at Essex County Coroner’s Court in Chelmsford heard how married Mrs Norris, who already had a three-year-old daughter called Lily, had suffered with anxiety since the age of 17.

Coroner Michelle Brown said opportunities to help her were missed in the run-up to her death.

The inquest heard how minutes before her death, Mrs Norris sent a text message to her husband Jeff which said: ‘I love you and Lily with all my heart, it’s not your fault I’m like this, I can’t cope anymore, I’m sorry.’

The hearing was told that the teaching assistant had a long-term prescription for anti-anxiety drug Venlafaxine to help manage her symptoms but stopped taking the drug on doctors’ advice when she fell pregnant with her second child.

However, she was prescribed Diazepam after complaining of constant morning sickness and was put back on a low-dosage of Venlafaxine in February last year after telling her GP, Dr Adekunle Olowu, that she was ‘unable to cope’.

The inquest heard that Dr Olowu failed to warn her of the possible side-effects of the anti-depressant.

During the hearing, Norris family counsel Vanessa Marshall grilled Dr Owolu about the decision to prescribe Venlafaxine again.

She asked him: ‘Isn’t it the case that in the early stages of taking Venlafaxine it can cause an increased risk of self-harm or suicidal thoughts?

‘That is an established side-effect of the medication in some cases.

‘It was irrelevant that she had taken it over the years. Each period of taking it is different.’

Dr Olowu said he did not consider there to be a risk due to the reduced amount prescribed, as well as Mrs Norris’ previous experience taking the medication, but admitted he did not warn her of the increased risk.

The inquest also heard how on the day of her death Mrs Norris phoned a mental health crisis team twice and informed them that she was having thoughts about jumping in front of a train.

A nurse arranged a visit to her house later that day but when she arrived four hours later Mrs Norris had already died.

The coroner returned a verdict of suicide but said opportunities to help Mrs Norris had been missed by medical professionals.

She said: ‘Opportunities have been missed in respect of the initial referral to the hospital from the GPs’ practice and the lack of adequate recording in the GPs’ notes meant the evidence was insufficient to ascertain whether she stopped taking the drugs of her own accord or because she was advised to do so.

‘There is also insufficient evidence to show whether restarting the Venlafaxine contributed to her death, or whether the Diazepam was prescribed for sickness or anxiety.

‘However these were clinical decisions made by medical professionals and outside the remit of this inquest.’

The Norris family’s solicitors, Thompson Smith and Puxon, said an investigation into her death by the North Essex Partnership NHS Foundation Trust’s mental health service had highlighted ‘various areas of her care that were of concern’.

It said Mrs Norris was left to seek help herself instead of being referred to experts by professionals.

A similar probe by Colchester General Hospital found care may not have been provided to a standard which may have averted her death.

Solicitor Naomi Eady, who represented Mr Norris at the inquest, said: ‘It is of great concern to Joanne’s family both investigating trusts are critical of the care she received on a number of different levels.’

Mrs Norris, who suffered with severe anxiety from the age of 17, died after walking into the path of a speeding train at Witham station, Essex (pictured), on March 16 last year. A coroner recorded a verdict of suicide

Mrs Norris, who suffered with severe anxiety from the age of 17, died after walking into the path of a speeding train at Witham station, Essex (pictured), on March 16 last year. A coroner recorded a verdict of suicide

The law firm added: ‘Based on the evidence presented at the inquest the family will be pursuing a claim.’

The inquest also heard how Mrs Norris’ GP surgery, East Lynne Medical Centre in Clacton-on-Sea, had since changed its procedures to ensure that all expectant mothers are reviewed for mental health problems.

The surgery is also in the process of making improvements to the way it shares information with other health services, the hearing was told.

Colchester Hospital University NHS Foundation Trust has also installed a new computer system which lets GPs access patient records in a bid to reduce communication problems.

Read more: http://www.dailymail.co.uk/news/article-2970019/Pregnant-woman-killed-train-doctor-failed-warn-anxiety-drug-cause-suicidal-feelings.html#ixzz3SsSXk6BEWatch movie online The Transporter Refueled (2015)

Widely-used painkiller now only available on prescription after being linked to heart problems

  • Diclofenac, an anti-inflammatory drug, has been reclassified
  • Is used by millions for conditions such as back pain, arthritis and gout
  • But there were fears the drug could also cause heart problems
  • Has now been re-classified and will only be available on prescription  

An over-the-counter painkiller used by millions will no longer be sold in pharmacies from today, over fears that it could raise the risk of heart attacks and strokes.

Diclofenac pills will now only be available with a prescription.

The Medicines and Healthcare products Regulatory Agency said the painkilling and anti-inflammatory tablets, widely bought under the brand name Voltarol, carry a ‘small but increased’ risk of heart problems.

Diclofenac, an anti-inflammatory drug, has been reclassified by the UK healthcare regulator as a prescription-only medicine after concerns it may cause heart problems for some patients 

Diclofenac, an anti-inflammatory drug, has been reclassified by the UK healthcare regulator as a prescription-only medicine after concerns it may cause heart problems for some patients

Painkilling gels that contain diclofenac will still be available over the counter, however.

Diclofenac accounts for six million prescriptions, and it is thought that tens of thousands buy Voltarol directly over the counter.

The pills are non-steroidal anti-inflammatory drugs (NSAIDs), which are used to relieve pain caused by conditions including arthritis, gout, headaches and flu.

In 2013, Oxford University researchers found high doses of NSAIDs can increase the risk of heart attacks and strokes.

 A review by European health officials confirmed the finding, and said patients should no longer use diclofenac if they have a heart condition, or have previously suffered heart attacks or strokes.

HOW THE PILLS CAN PUT YOUR LIFE AT RISK 

Diclofenac – the active ingredient in Voltarol – offers fast relief from pain and inflammation associated with back, neck and muscle aches.

It also gives short-term relief from headaches, toothache, period pain and cold and flu symptoms.

It blocks a substance in the body called cyclo-oxygenase, which produces chemicals in response to injury – causing pain, swelling and inflammation. 

In 2013, a major Oxford University study found that for every 1,000 people with a moderate risk of heart disease taking 150mg a day for a year, about three would experience an avoidable heart attack, of which one would be fatal.

Diclofenac can also cause serious side-effects in the gut, such as ulceration, bleeding or perforation of the stomach or intestinal lining.

The MHRA’s Commission on Human Medicines concluded that these side-effects could ‘not be ruled out’ even at lower doses, or when diclofenac is taken for a short time.

Pills containing diclofenac remain available over the counter in many other countries, including Germany, Italy and Australia.

However, the MHRA’s Sarah Branch said: ‘Diclofenac is associated with a small but increased risk of serious cardiac side effects in some patients, particularly if used at high doses and for long-term treatment.

Because of this, the Commission on Human Medicines has advised that patients need to have a medical review before taking oral diclofenac to make sure it is suitable for them.

‘If patients have recently bought diclofenac tablets and continue to need pain relief they should talk to their pharmacist about suitable alternative treatments.’

Dr Branch said those prescribed diclofenac by a doctor should continue to take their medicine as instructed, as their medical history has already been assessed.

Dr Phil Berry, head of clinical safety at Voltarol manufacturer Novartis, warned: ‘Those who want to continue taking oral instant knockout diclofenac are now going to have to go to their GP which, in view of the current situation in the UK with A&E, is worrying.’

Six million prescriptions were written for diclofenac last year and the drug is also available over the counter in lower dose Voltarol tablets and cream

Six million prescriptions were written for diclofenac last year and the drug is also available over the counter in lower dose Voltarol tablets and cream

Read more:

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Release : November 2, 2011
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Runtime : 104
Genre : Action, Comedy.

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Director : Chad Stahelski
Release : February 08, 2017
Production Company : Thunder Road Pictures, 87Eleven, LionsGate
Language : en
Runtime : 122 min.
Genre : Crime, Thriller, Action.

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‘John Wick: Chapter 2’ is exelent movie tell story about John Wick is forced out of retirement by a former associate looking to seize control of a shadowy international assassins’ guild. Bound by a blood oath to aid him, Wick travels to Rome and does battle against some of the world’s most dangerous killers. This movie have genre Crime, Thriller, Action and have 122 minutes runtime.

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Common as Cassian, Keanu Reeves as John Wick, John Leguizamo as Aurelio, Laurence Fishburne as The Bowler King, Riccardo Scamarcio as Santino D’Antonio, Ruby Rose as Ares.

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NICE Guidelines : Antenatal and postnatal mental health: clinical management and service guidance

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NICE guidelines [CG192] Published date: December 2014

In pregnancy and the postnatal period, many mental health problems have a similar nature, course and potential for relapse as at other times. However, there can be differences; for example, bipolar disorder shows an increased rate of relapse and first presentation in the postnatal period. Some changes in mental health state and functioning (such as appetite) may represent normal pregnancy changes, but they may be a symptom of a mental health problem.

The management of mental health problems during pregnancy and the postnatal period differs from at other times because of the nature of this life stage and the potential impact of any difficulties and treatments on the woman and the baby. There are risks associated with taking psychotropic medication in pregnancy and during breastfeeding and risks of stopping medication taken for an existing mental health problem. There is also an increased risk of postpartum psychosis.

Depression and anxiety are the most common mental health problems during pregnancy, with around 12% of women experiencing depression and 13% experiencing anxiety at some point; many women will experience both. Depression and anxiety also affect 15‑20% of women in the first year after childbirth. During pregnancy and the postnatal period, anxiety disorders, including panic disorder, generalised anxiety disorder (GAD), obsessive‑compulsive disorder (OCD), post‑traumatic stress disorder (PTSD) and tokophobia (an extreme fear of childbirth), can occur on their own or can coexist with depression. Psychosis can re‑emerge or be exacerbated during pregnancy and the postnatal period. Postpartum psychosis affects between 1 and 2 in 1000 women who have given birth. Women with bipolar I disorder are at particular risk, but postpartum psychosis can occur in women with no previous psychiatric history.

Changes to body shape, including weight gain, in pregnancy and after childbirth may be a concern for women with an eating disorder. Although the prevalence of anorexia nervosa and bulimia nervosa is lower in pregnant women, the prevalence of binge eating disorder is higher. Smoking and the use of illicit drugs and alcohol in pregnancy are common, and prematurity, intrauterine growth restriction and fetal compromise are more common in women who use these substances, particularly women who smoke.

Between 2006 and 2008 there were 1.27 maternal deaths per 100,000 maternal deliveries in the UK as a result of mental health problems. Although response to treatment for mental health problems is good, these problems frequently go unrecognised and untreated in pregnancy and the postnatal period. If untreated, women can continue to have symptoms, sometimes for many years, and these can also affect their babies and other family members.

This guideline makes recommendations for the recognition, assessment, care and treatment of mental health problems in women during pregnancy and the postnatal period (up to 1 year after childbirth) and in women who are planning a pregnancy. The guideline covers depression, anxiety disorders, eating disorders, drug and alcohol‑use disorders and severe mental illness (such as psychosis, bipolar disorder, schizophrenia and severe depression). It covers subthreshold symptoms as well as mild, moderate and severe mental health problems. However, the guideline focuses on aspects of expression, risks and management that are of special relevance in pregnancy and the postnatal period.

The recommendations are relevant to all healthcare professionals who recognise, assess and refer for or provide interventions for mental health problems in pregnancy and the postnatal period. It will also be relevant to non‑NHS services, such as social services and the voluntary and private sectors, but does not make specific recommendations for these. The guideline also makes recommendations about the primary and secondary care services needed to support the effective identification and treatment of most mental health problems in pregnancy and the postnatal period. This guideline should be read in conjunction with other NICE guidelines on the treatment and management of specific mental health problems. The guideline indicates where modifications to treatment and management are needed in pregnancy and the postnatal period.

The guideline draws on the best available evidence. However, there are significant limitations to the evidence base, including limited data on the risks of psychotropic medication in pregnancy and during breastfeeding.