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Tokariev A, Oberlander VC, Videman M, Vanhatalo S. Cortical Cross-Frequency Coupling Is Affected by in utero Exposure to Antidepressant Medication. Front Neurosci 2022; 16:803708. [PMID: 35310093 PMCID: PMC8927083 DOI: 10.3389/fnins.2022.803708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022] Open
Abstract
Up to five percent of human infants are exposed to maternal antidepressant medication by serotonin reuptake inhibitors (SRI) during pregnancy, yet the SRI effects on infants’ early neurodevelopment are not fully understood. Here, we studied how maternal SRI medication affects cortical frequency-specific and cross-frequency interactions estimated, respectively, by phase-phase correlations (PPC) and phase-amplitude coupling (PAC) in electroencephalographic (EEG) recordings. We examined the cortical activity in infants after fetal exposure to SRIs relative to a control group of infants without medical history of any kind. Our findings show that the sleep-related dynamics of PPC networks are selectively affected by in utero SRI exposure, however, those alterations do not correlate to later neurocognitive development as tested by neuropsychological evaluation at two years of age. In turn, phase-amplitude coupling was found to be suppressed in SRI infants across multiple distributed cortical regions and these effects were linked to their neurocognitive outcomes. Our results are compatible with the overall notion that in utero drug exposures may cause subtle, yet measurable changes in the brain structure and function. Our present findings are based on the measures of local and inter-areal neuronal interactions in the cortex which can be readily used across species, as well as between different scales of inspection: from the whole animals to in vitro preparations. Therefore, this work opens a framework to explore the cellular and molecular mechanisms underlying neurodevelopmental SRI effects at all translational levels.
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Affiliation(s)
- Anton Tokariev
- Department of Clinical Neurophysiology, BABA Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- *Correspondence: Anton Tokariev,
| | - Victoria C. Oberlander
- Department of Clinical Neurophysiology, BABA Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Mari Videman
- Department of Clinical Neurophysiology, BABA Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Pediatric Neurology, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, BABA Center, New Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Neuroscience Center, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Physiology, University of Helsinki, Helsinki, Finland
- Sampsa Vanhatalo,
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2
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Early development of sleep and brain functional connectivity in term-born and preterm infants. Pediatr Res 2022; 91:771-786. [PMID: 33859364 DOI: 10.1038/s41390-021-01497-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 12/22/2022]
Abstract
The proper development of sleep and sleep-wake rhythms during early neonatal life is crucial to lifelong neurological well-being. Recent data suggests that infants who have poor quality sleep demonstrate a risk for impaired neurocognitive outcomes. Sleep ontogenesis is a complex process, whereby alternations between rudimentary brain states-active vs. wake and active sleep vs. quiet sleep-mature during the last trimester of pregnancy. If the infant is born preterm, much of this process occurs in the neonatal intensive care unit, where environmental conditions might interfere with sleep. Functional brain connectivity (FC), which reflects the brain's ability to process and integrate information, may become impaired, with ensuing risks of compromised neurodevelopment. However, the specific mechanisms linking sleep ontogenesis to the emergence of FC are poorly understood and have received little investigation, mainly due to the challenges of studying causal links between developmental phenomena and assessing FC in newborn infants. Recent advancements in infant neuromonitoring and neuroimaging strategies will allow for the design of interventions to improve infant sleep quality and quantity. This review discusses how sleep and FC develop in early life, the dynamic relationship between sleep, preterm birth, and FC, and the challenges associated with understanding these processes. IMPACT: Sleep in early life is essential for proper functional brain development, which is essential for the brain to integrate and process information. This process may be impaired in infants born preterm. The connection between preterm birth, early development of brain functional connectivity, and sleep is poorly understood. This review discusses how sleep and brain functional connectivity develop in early life, how these processes might become impaired, and the challenges associated with understanding these processes. Potential solutions to these challenges are presented to provide direction for future research.
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3
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Horackova H, Karahoda R, Cerveny L, Vachalova V, Ebner R, Abad C, Staud F. Effect of Selected Antidepressants on Placental Homeostasis of Serotonin: Maternal and Fetal Perspectives. Pharmaceutics 2021; 13:pharmaceutics13081306. [PMID: 34452265 PMCID: PMC8397948 DOI: 10.3390/pharmaceutics13081306] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022] Open
Abstract
Depression is a prevalent condition affecting up to 20% of pregnant women. Hence, more than 10% are prescribed antidepressant drugs, mainly serotonin reuptake inhibitors (SSRIs) and selective serotonin and noradrenaline reuptake inhibitors (SNRIs). We hypothesize that antidepressants disturb serotonin homeostasis in the fetoplacental unit by inhibiting serotonin transporter (SERT) and organic cation transporter 3 (OCT3) in the maternal- and fetal-facing placental membranes, respectively. Paroxetine, citalopram, fluoxetine, fluvoxamine, sertraline, and venlafaxine were tested in situ (rat term placenta perfusion) and ex vivo (uptake studies in membrane vesicles isolated from healthy human term placenta). All tested antidepressants significantly inhibited SERT- and OCT3-mediated serotonin uptake in a dose-dependent manner. Calculated half-maximal inhibitory concentrations (IC50) were in the range of therapeutic plasma concentrations. Using in vitro and in situ models, we further showed that the placental efflux transporters did not compromise mother-to-fetus transport of antidepressants. Collectively, we suggest that antidepressants have the potential to affect serotonin levels in the placenta or fetus when administered at therapeutic doses. Interestingly, the effect of antidepressants on serotonin homeostasis in rat placenta was sex dependent. As accurate fetal programming requires optimal serotonin levels in the fetoplacental unit throughout gestation, inhibition of SERT-/OCT3-mediated serotonin uptake may help explain the poor outcomes of antidepressant use in pregnancy.
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4
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Lawrence RH, Palumbo MC, Freeman SM, Guoynes CD, Bales KL. Developmental Fluoxetine Exposure Alters Behavior and Neuropeptide Receptors in the Prairie Vole. Front Behav Neurosci 2020; 14:584731. [PMID: 33304247 PMCID: PMC7701284 DOI: 10.3389/fnbeh.2020.584731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022] Open
Abstract
Developmental exposure to selective serotonin reuptake inhibitor (SSRI) increases the risk of Autism Spectrum Disorder (ASD), however, the underlying neurobiology of this effect is not fully understood. Here we used the socially monogamous prairie vole as a translational model of developmental SSRI exposure. Paired female prairie voles (n = 20) were treated with 5 mg/kg subcutaneous fluoxetine (FLX) or saline (SAL) daily from birth of the second litter until the day of birth of the 4th litter. This design created three cohorts of FLX exposure: postnatal exposure in litter 2, both prenatal and postnatal exposure in litter 3, and prenatal exposure in litter 4. Post-weaning, subjects underwent behavioral testing to detect changes in sociality, repetitive behavior, pair-bond formation, and anxiety-like behavior. Quantitative receptor autoradiography was performed for oxytocin, vasopressin 1a, and serotonin 1a receptor density in a subset of brains. We observed increased anxiety-like behavior and reduced sociality in developmentally FLX exposed adults. FLX exposure decreased oxytocin receptor binding in the nucleus accumbens core and central amygdala, and vasopressin 1a receptor binding in the medial amygdala. FLX exposure did not affect serotonin 1A receptor binding in any areas examined. Changes to oxytocin and vasopressin receptors may underlie the behavioral changes observed and have translational implications for the mechanism of the increased risk of ASD subsequent to prenatal SSRI exposure.
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Affiliation(s)
- Rebecca H Lawrence
- Department of Psychology, University of California, Davis, Davis, CA, United States.,California National Primate Research Center, University of California, Davis, Davis, CA, United States
| | - Michelle C Palumbo
- California National Primate Research Center, University of California, Davis, Davis, CA, United States.,Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, United States
| | - Sara M Freeman
- Department of Psychology, University of California, Davis, Davis, CA, United States.,California National Primate Research Center, University of California, Davis, Davis, CA, United States.,Department of Biology, Utah State University, Logan, UT, United States
| | - Caleigh D Guoynes
- Department of Psychology, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of Wisconsin, Madison, WI, United States
| | - Karen L Bales
- Department of Psychology, University of California, Davis, Davis, CA, United States.,California National Primate Research Center, University of California, Davis, Davis, CA, United States.,Department of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, CA, United States
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5
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Rotem-Kohavi N, Williams LJ, Oberlander TF. Advanced neuroimaging: A window into the neural correlates of fetal programming related to prenatal exposure to maternal depression and SSRIs. Semin Perinatol 2020; 44:151223. [PMID: 32122645 DOI: 10.1016/j.semperi.2020.151223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fetal programming is a conceptual framework whereby the in utero environment shapes the offspring's neurodevelopment. Maternal depression and treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy are common prenatal exposures that affect critical early life developmental programming processes. Prenatal depression and SSRIs both have been reported to increase the risks for preterm birth, low birth weight, and are associated with behavioral disturbances across the early life span. However, not all exposures lead to adverse developmental outcomes and distinguishing how each exposure contributes to variations in development remains challenging. Advances in neuroimaging, using MR and EEG, offer novel insights into central processes that might reveal the neural correlates of fetal programming. This review focuses on emerging findings from neuroimaging studies reflecting early brain functional and structural development associated with prenatal exposure to maternal depression and SSRI antidepressants. Suggestions for future research directions that use neuroimaging as a tool to advancing our understanding of the early origins of developmental plasticity are offered.
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Affiliation(s)
- Naama Rotem-Kohavi
- Graduate Program in Neuroscience, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | | | - Tim F Oberlander
- BC Children's Hospital Research Institute, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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6
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Marchi V, Stevenson N, Koolen N, Mazziotti R, Moscuzza F, Salvadori S, Pieri R, Ghirri P, Guzzetta A, Vanhatalo S. Measuring Cot-Side the Effects of Parenteral Nutrition on Preterm Cortical Function. Front Hum Neurosci 2020; 14:69. [PMID: 32256325 PMCID: PMC7090162 DOI: 10.3389/fnhum.2020.00069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/14/2020] [Indexed: 01/08/2023] Open
Abstract
Early nutritional compromise after preterm birth is shown to affect long-term neurodevelopment, however, there has been a lack of early functional measures of nutritional effects. Recent progress in computational electroencephalography (EEG) analysis has provided means to measure the early maturation of cortical activity. Our study aimed to explore whether computational metrics of early sequential EEG recordings could reflect early nutritional care measured by energy and macronutrient intake in the first week of life. A higher energy or macronutrient intake was assumed to associate with improved development of the cortical activity. We analyzed multichannel EEG recorded at 32 weeks (32.4 ± 0.7) and 36 weeks (36.6 ± 0.9) of postmenstrual age in a cohort of 28 preterm infants born before 32 weeks of postmenstrual age (range: 24.3–32 weeks). We computed several quantitative EEG measures from epochs of quiet sleep (QS): (i) spectral power; (ii) continuity; (iii) interhemispheric synchrony, as well as (iv) the recently developed estimate of maturational age. Parenteral nutritional intake from day 1 to day 7 was monitored and clinical factors collected. Lower calories and carbohydrates were found to correlate with a higher reduction of spectral amplitude in the delta band. Lower protein amount associated with higher discontinuity. Both higher proteins and lipids intake correlated with a more developmental increase in interhemispheric synchrony as well as with better progress in the estimate of EEG maturational age (EMA). Our study shows that early nutritional balance after preterm birth may influence subsequent maturation of brain activity in a way that can be observed with several intuitively reasoned and transparent computational EEG metrics. Such measures could become early functional biomarkers that hold promise for benchmarking in the future development of therapeutic interventions.
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Affiliation(s)
- Viviana Marchi
- Institute of Life Sciences, Scuola Superiore San'Anna, Pisa, Italy.,Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,BABA Center, Pediatric Research Center, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Nathan Stevenson
- BABA Center, Pediatric Research Center, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neurophysiology and Neuroscience Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Brain Modelling Group, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Ninah Koolen
- BABA Center, Pediatric Research Center, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | | | - Francesca Moscuzza
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Rossella Pieri
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Paolo Ghirri
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, Santa Chiara Hospital, University of Pisa, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sampsa Vanhatalo
- BABA Center, Pediatric Research Center, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neurophysiology and Neuroscience Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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7
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Maternal Fluoxetine Exposure Alters Cortical Hemodynamic and Calcium Response of Offspring to Somatosensory Stimuli. eNeuro 2019; 6:ENEURO.0238-19.2019. [PMID: 31843753 PMCID: PMC6978917 DOI: 10.1523/eneuro.0238-19.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/04/2019] [Accepted: 11/17/2019] [Indexed: 11/21/2022] Open
Abstract
Epidemiological studies have found an increased incidence of neurodevelopmental disorders in populations prenatally exposed to selective serotonin reuptake inhibitors (SSRIs). Optical imaging provides a minimally invasive way to determine if perinatal SSRI exposure has long-term effects on cortical function. Herein we probed the functional neuroimaging effects of perinatal SSRI exposure in a fluoxetine (FLX)-exposed mouse model. Epidemiological studies have found an increased incidence of neurodevelopmental disorders in populations prenatally exposed to selective serotonin reuptake inhibitors (SSRIs). Optical imaging provides a minimally invasive way to determine if perinatal SSRI exposure has long-term effects on cortical function. Herein we probed the functional neuroimaging effects of perinatal SSRI exposure in a fluoxetine (FLX)-exposed mouse model. While resting-state homotopic contralateral functional connectivity was unperturbed, the evoked cortical response to forepaw stimulation was altered in FLX mice. The stimulated cortex showed decreased activity for FLX versus controls, by both hemodynamic responses [oxyhemoglobin (HbO2)] and neuronal calcium responses (Thy1-GCaMP6f fluorescence). Significant alterations in both cortical HbO2 and calcium response amplitude were seen in the cortex ipsilateral to the stimulated paw in FLX as compared to controls. The cortical regions of largest difference in activation between FLX and controls also were consistent between HbO2 and calcium contrasts at the end of stimulation. Taken together, these results suggest a global loss of response signal amplitude in FLX versus controls. These findings indicate that perinatal SSRI exposure has long-term consequences on somatosensory cortical responses.
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8
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Grieve PG, Fifer WP, Cousy NP, Monk CE, Stark RI, Gingrich JA, Myers MM. Neonatal infant EEG bursts are altered by prenatal maternal depression and serotonin selective reuptake inhibitor use. Clin Neurophysiol 2019; 130:2019-2025. [PMID: 31539768 DOI: 10.1016/j.clinph.2019.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 08/03/2019] [Accepted: 08/24/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Increasingly, serotonin selective reuptake inhibitor (SSRI) medications are prescribed in pregnancy. These medications pass freely into the developing fetus but little is known about their effect on brain development in humans. In this study we determine if prenatal maternal depression and SSRI medication change the EEG infant delta brush bursts which are an early marker of normal brain maturation. METHODS We measured delta brush bursts from the term infants of three groups of mothers (controls (N = 52), depressed untreated (N = 15), and those taking serotonin SSRI medication (N = 10). High density EEGs were obtained during sleep at an average age of 44 weeks post conceptional age. We measured the rate of occurrence, brush amplitude, oscillation frequency and duration of the bursts. RESULTS Compared to infants of control mothers, the parameters of delta brush bursts of the offspring of depressed and SSRI-using mothers are significantly altered: burst amplitude is decreased; the oscillation frequency increased, and the duration increased (SSRI only). These significant differences were found during both sleep states. CONCLUSIONS Electrocortical bursting activity (i.e. delta brushes) is known to play an important role in early central nervous system (CNS) synaptic formation and function. SIGNIFICANCE Maternal depression or SSRI use may alter brain function in their offspring.
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Affiliation(s)
- P G Grieve
- Department of Pediatrics, Columbia University, New York, NY 10032, USA.
| | - W P Fifer
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
| | - N P Cousy
- Cape Services, 22 rue Pierre Mendès, Torcy 77200, France
| | - C E Monk
- Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA
| | - R I Stark
- Department of Pediatrics, Columbia University, New York, NY 10032, USA
| | - J A Gingrich
- Columbia University Medical Center, Psychiatry, New York, NY 10032, USA
| | - M M Myers
- Columbia University Medical Center, Psychiatry, New York, NY 10032, USA
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9
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Tokariev A, Roberts JA, Zalesky A, Zhao X, Vanhatalo S, Breakspear M, Cocchi L. Large-scale brain modes reorganize between infant sleep states and carry prognostic information for preterms. Nat Commun 2019; 10:2619. [PMID: 31197175 PMCID: PMC6565810 DOI: 10.1038/s41467-019-10467-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/06/2019] [Indexed: 12/18/2022] Open
Abstract
Sleep architecture carries vital information about brain health across the lifespan. In particular, the ability to express distinct vigilance states is a key physiological marker of neurological wellbeing in the newborn infant although systems-level mechanisms remain elusive. Here, we demonstrate that the transition from quiet to active sleep in newborn infants is marked by a substantial reorganization of large-scale cortical activity and functional brain networks. This reorganization is attenuated in preterm infants and predicts visual performance at two years. We find a striking match between these empirical effects and a computational model of large-scale brain states which uncovers fundamental biophysical mechanisms not evident from inspection of the data. Active sleep is defined by reduced energy in a uniform mode of neural activity and increased energy in two more complex anteroposterior modes. Preterm-born infants show a deficit in this sleep-related reorganization of modal energy that carries novel prognostic information.
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Affiliation(s)
- Anton Tokariev
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia. .,Department of Clinical Neurophysiology, Clinicum, University of Helsinki, 00014, Helsinki, Finland. .,BABA center, Pediatric Research Center, Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital, 00029, Helsinki, Finland.
| | - James A Roberts
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, VIC, 3053, Australia.,Department of Biomedical Engineering, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Xuelong Zhao
- Department of Bioengineering, School of Engineering & Applied Science, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, Clinicum, University of Helsinki, 00014, Helsinki, Finland.,BABA center, Pediatric Research Center, Clinical Neurophysiology, Children's Hospital, Helsinki University Central Hospital, 00029, Helsinki, Finland
| | - Michael Breakspear
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, 2305, Australia
| | - Luca Cocchi
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia. .,School of Medicine, University of Queensland, Brisbane, QLD, 4006, Australia.
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10
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Lugo-Candelas C, Cha J, Hong S, Bastidas V, Weissman M, Fifer WP, Myers M, Talati A, Bansal R, Peterson BS, Monk C, Gingrich JA, Posner J. Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy. JAMA Pediatr 2018; 172:525-533. [PMID: 29630692 PMCID: PMC6137537 DOI: 10.1001/jamapediatrics.2017.5227] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Selective serotonin reuptake inhibitor (SSRI) use among pregnant women is increasing, yet the association between prenatal SSRI exposure and fetal neurodevelopment is poorly understood. Animal studies show that perinatal SSRI exposure alters limbic circuitry and produces anxiety and depressive-like behaviors after adolescence, but literature on prenatal SSRI exposure in humans is limited and mixed. OBJECTIVE To examine associations between prenatal SSRI exposure and brain development using structural and diffusion magnetic resonance imaging (MRI). DESIGN, SETTING, AND PARTICIPANTS A cohort study conducted at Columbia University Medical Center and New York State Psychiatric Institute included 98 infants: 16 with in utero SSRI exposure, 21 with in utero untreated maternal depression exposure, and 61 healthy controls. Data were collected between January 6, 2011, and October 25, 2016. EXPOSURES Selective serotonin reuptake inhibitors and untreated maternal depression. MAIN OUTCOMES AND MEASURES Gray matter volume estimates using structural MRI with voxel-based morphometry and white matter structural connectivity (connectome) using diffusion MRI with probabilistic tractography. RESULTS The sample included 98 mother (31 [32%] white, 26 [27%] Hispanic/Latina, 26 [27%] black/African American, 15 [15%] other) and infant (46 [47%] boys, 52 [53%] girls) dyads. Mean (SD) age of the infants at the time of the scan was 3.43 (1.50) weeks. Voxel-based morphometry showed significant gray matter volume expansion in the right amygdala (Cohen d = 0.65; 95% CI, 0.06-1.23) and right insula (Cohen d = 0.86; 95% CI, 0.26-1.14) in SSRI-exposed infants compared with both healthy controls and infants exposed to untreated maternal depression (P < .05; whole-brain correction). In connectome-level analysis of white matter structural connectivity, the SSRI group showed a significant increase in connectivity between the right amygdala and the right insula with a large effect size (Cohen d = 0.99; 95% CI, 0.40-1.57) compared with healthy controls and untreated depression (P < .05; whole connectome correction). CONCLUSIONS AND RELEVANCE Our findings suggest that prenatal SSRI exposure has an association with fetal brain development, particularly in brain regions critical to emotional processing. The study highlights the need for further research on the potential long-term behavioral and psychological outcomes of these neurodevelopmental changes.
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Affiliation(s)
- Claudia Lugo-Candelas
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Jiook Cha
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Susie Hong
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Vanessa Bastidas
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York
| | - Myrna Weissman
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
| | - William P. Fifer
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
| | - Michael Myers
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
| | - Ardesheer Talati
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
| | - Ravi Bansal
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California,Department of Psychiatry, Institute for the Developing Mind, Los Angeles, California
| | - Bradley S. Peterson
- Department of Pediatrics, Keck School of Medicine, Los Angeles, California,Department of Psychiatry, Institute for the Developing Mind, Los Angeles, California
| | - Catherine Monk
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
| | - Jay A. Gingrich
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
| | - Jonathan Posner
- Department of Psychiatry, Columbia University Medical Center, New York, New York,New York State Psychiatric Institute, New York,Sackler Institute for Developmental Psychobiology, Columbia University Medical Center, New York, New York
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11
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Khazipov R, Milh M. Early patterns of activity in the developing cortex: Focus on the sensorimotor system. Semin Cell Dev Biol 2018; 76:120-129. [DOI: 10.1016/j.semcdb.2017.09.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 02/08/2023]
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12
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Liu X, Agerbo E, Ingstrup KG, Musliner K, Meltzer-Brody S, Bergink V, Munk-Olsen T. Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ 2017; 358:j3668. [PMID: 28877907 PMCID: PMC5594425 DOI: 10.1136/bmj.j3668] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.Design Population based cohort study.Setting Danish national registers.Participants 905 383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July 2014, death, emigration, or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×106 person years at risk.Exposures for observational studies Children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy), and new user (use only during pregnancy).Main outcome measure First psychiatric diagnosis in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.Results Overall, psychiatric disorders were diagnosed in 32 400 children. The adjusted 15 year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased risk of psychiatric disorders (hazard ratio 1.27, 1.17 to 1.38), compared with the discontinuation group.Conclusions In utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. The findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.
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Affiliation(s)
- Xiaoqin Liu
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
- CIRRAU-Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Katja G Ingstrup
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Katherine Musliner
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Veerle Bergink
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Trine Munk-Olsen
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
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13
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Allegaert K, Simons SHP, Tibboel D, Krekels EH, Knibbe CA, van den Anker JN. Non-maturational covariates for dynamic systems pharmacology models in neonates, infants, and children: Filling the gaps beyond developmental pharmacology. Eur J Pharm Sci 2017; 109S:S27-S31. [PMID: 28506866 DOI: 10.1016/j.ejps.2017.05.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 02/07/2023]
Abstract
Pharmacokinetics and -dynamics show important changes throughout childhood. Studies on the different maturational processes that influence developmental pharmacology have been used to create population PK/PD models that can yield individualized pediatric drug dosages. These models were subsequently translated to semi-physiologically or physiology-based PK (PBPK) models that support predictions in pediatric patient cohorts and other special populations. Although these translational efforts are crucial, these models should be further improved towards individual patient predictions by including knowledge on non-maturational covariates. These efforts are needed to ultimately get to systems pharmacology models for children. These models take developmental changes relating to the pediatric dynamical system into account but also other aspects that may be of importance such as abnormal body composition, pharmacogenetics, critical illness and inflammatory status.
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Affiliation(s)
- Karel Allegaert
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Development and Regeneration KU Leuven, Leuven, Belgium
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Elke H Krekels
- Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden, the Netherlands
| | - Catherijne A Knibbe
- Division of Pharmacology, Leiden Academic Center for Drug Research, Leiden, the Netherlands; Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - John N van den Anker
- Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Division of Clinical Pharmacology, Children's National Health System, Washington, DC, USA; Division of Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
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14
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Hermansen TK, Yrttiaho S, Røysamb E, Melinder A. Perceptual interference processing in preschool children, with and without prenatal exposure to selective serotonin reuptake inhibitors. Psychopharmacology (Berl) 2017; 234:339-351. [PMID: 27826628 DOI: 10.1007/s00213-016-4467-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prenatal exposure to maternal depression, with or without maternal medical antidepressant treatment, may pose a risk to the child's cognitive and behavioral development. Targeting one of the core functions of behavioral regulation, we investigated both behavioral and neural indices of interference suppression in both exposed and control participants at preschool age. METHODS Children (N = 80, M = 68.60 months, SD = 5.57) with prenatal exposure to maternal depression with (SSRI, N = 21) and without (DEP, N = 33) antidepressant treatment were tested together with unexposed children (CON, N = 26) on a behavioral flanker task while recording event-related potentials (ERPs). ERPs were extracted from trials with congruent/incongruent flankers and speeded/slow response times (RT). FINDINGS Effects of flanker congruence were found in both behavioral indices and the late slow wave ERP (LSW, 500-800 ms), across all groups in the expected directions. Further, increased amplitude of the N2 (350-450 ms) and the LSW potential was found in trials with speeded vs slow RT. Interestingly, the parietal N2 in speeded trials showed decreased latency among children in the CON group but not among the other children. No other effects of group on ERP or behavioral measures were found. CONCLUSION While interference effects were evident in behavioral and ERP measures, prenatal exposure to SSRIs and DEP was not directly associated with abilities of interference suppression. However, RT in the flanker task was associated with N2 and LSW potentials. Importantly, the interaction between RT and participant group upon parietal N2 latency may suggest effects of prenatal exposure on neural efficiency.
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Affiliation(s)
- Tone Kristine Hermansen
- The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Forskningsveien 3a, 0373, Oslo, Norway.
| | - Santeri Yrttiaho
- Tampere Center for Child Health Research, School of Medicine, University of Tampere, Tampere, Finland
| | - Espen Røysamb
- The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Forskningsveien 3a, 0373, Oslo, Norway.,Division of Mental Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Annika Melinder
- The Cognitive Developmental Research Unit, Department of Psychology, University of Oslo, Forskningsveien 3a, 0373, Oslo, Norway
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15
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Thomas E, Peacock PJ, Bates SE. Variation in the management of SSRI-exposed babies across England. BMJ Paediatr Open 2017; 1:e000060. [PMID: 29637109 PMCID: PMC5862225 DOI: 10.1136/bmjpo-2017-000060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Depression in pregnancy is commonly treated using selective serotonin reuptake inhibitors (SSRIs). A possible withdrawal syndrome following in utero exposure has been reported, but there is currently no UK guidance on the management of these neonates. METHODS All 160 neonatal units in England were asked for information regarding their management of SSRI-exposed babies. RESULTS Responses were obtained from 112/160 (70%) units. Only four units had a specific protocol for managing SSRI-exposed neonates. Twenty-one units (19%) conduct routine observations on exposed neonates, while 37 units (33%) would consider treating babies with signs of withdrawal or toxicity. CONCLUSIONS Very few neonatal units in England have specific guidelines for the management of babies exposed to SSRIs in utero, with practice varying greatly between units. Further research is needed on the outcomes of SSRI-exposed babies to support development of standardised evidence-based guidelines to ensure all mothers and babies receive similar high-quality care.
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Affiliation(s)
- Eliza Thomas
- Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Phil J Peacock
- Department of Paediatrics, Great Western Hospital, Swindon, UK
| | - Sarah E Bates
- Department of Paediatrics, Great Western Hospital, Swindon, UK
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16
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Faa G, Manchia M, Pintus R, Gerosa C, Marcialis MA, Fanos V. Fetal programming of neuropsychiatric disorders. ACTA ACUST UNITED AC 2016; 108:207-223. [DOI: 10.1002/bdrc.21139] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Gavino Faa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine; University of Cagliari; Cagliari Italy
- Department of Pharmacology; Dalhousie University; Halifax Nova Scotia Canada
| | - Roberta Pintus
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Clara Gerosa
- Division of Pathology, Department of Surgery; University Hospital San Giovanni di Dio; Cagliari Italy
| | - Maria Antonietta Marcialis
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Neonatal Pathology and Neonatal Section; AOU Cagliari and University of Cagliari; Cagliari Italy
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