SSRIs during pregnancy and risk of autism spectrum disorder (January 2014)

Previous studies have suggested an association between use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy and an increased risk of autism spectrum disorders in offspring, but a recent national registry study of over 600,000 births provides reassuring data. The study identified nearly 4000 children with autism, including 52 who were exposed in utero to SSRIs. After adjusting for potential confounders, such as maternal parity, age, socioeconomic status, smoking status, psychiatric disorders, and other drugs used during pregnancy, use of SSRIs during pregnancy was not associated with an increased risk of autism. However, there was an increased risk of autism in children of women who received SSRIs before pregnancy but not during pregnancy. The authors concluded that the associations observed between antenatal SSRI exposure and autism in previous studies may have been attributable to the underlying indications for these medications (eg, maternal depression).

Fetal iron deficiency inhibits neural myelination (December 2013)

Iron deficiency in infancy has been associated with persistent changes in neural transmission through the auditory and visual systems, suggesting that myelination may be impaired. A new study suggests that the effects of iron deficiency on neural myelination and auditory brainstem responses (ABR) begin during fetal development. The subjects were neonates born in the United States with risk factors for neonatal iron deficiency (eg, maternal diabetes mellitus, pregnancy-induced hypertension, or intrauterine growth restriction). Infants with latent iron deficiency, as measured by ferritin concentrations in cord blood, had significantly prolonged ABR compared with infants without iron deficiency, after controlling for confounders.

New diagnostic criteria for preeclampsia (November 2013)

In 2013, the American College of Obstetricians and Gynecologists removed proteinuria as an essential diagnostic criterion for preeclampsia. Preeclampsia can now be diagnosed based on new onset of hypertension with either proteinuria or end-organ dysfunction after 20 weeks of gestation. Massive proteinuria and fetal growth restriction have also been removed as characteristics of severe disease. 

In a randomized trial of over 800 women with twin gestations, use of a cervical pessary inserted between 16 and 20 weeks gestation, compared to no pessary, did not reduce preterm birth or a composite of poor perinatal outcomes. Although a benefit was found in a subgroup of pregnancies whose cervical length was in the lowest quartile (less than 38 mm), methodologic concerns limit the validity of this finding. We do not use pessaries to prevent preterm birth in twin pregnancies. 

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