read with curiosity the paper by De Vera and Bérard Caspofungin Acetate [1] evaluating the association between antidepressant use during pregnancy and pregnancy-induced hypertension. data from births at a US hospital during 1999-2000 reporting a lower overall positive predictive worth of 54% [4]. This ranged from 45.3% for instances of mild pre-eclampsia to 84.8% for cases of severe pre-eclampsia. Low relationship between your disease and ICD-9 rules could lead to an underestimation of reported associations assuming the degree of correlation is not associated with the underlying disease. Importantly Caspofungin Acetate and of more serious concern is the potential for differential misclassification of outcomes because the direction and magnitude of the bias would largely be unknown. Such differential outcome misclassification could occur if there are differences in the recording of outcomes according to additional factors that are also associated Caspofungin Acetate with the use of antidepressants or are directly associated with the underlying disease. For example women using antidepressants may be more likely to visit medical practitioners and subsequently more likely to be diagnosed with gestational hypertension. Secondly it would be useful to possess data on the sort and severity from the gestational hypertension like the percentage of females with pre-eclampsia. Toh et al. [3] previously determined a more powerful association with prenatal selective serotonin reuptake inhibitor (SSRI) publicity and gestational hypertension with pre-eclampsia (3.91; 95% self-confidence period 2.39-6.39) than with gestational hypertension without pre-eclampsia (1.61; 95% self-confidence period 1.03-2.53). If the threat of pre-eclampsia differs from the chance of gestational hypertension without pre-eclampsia needs further clarification but will be of scientific relevance in the administration of the condition and females acquiring antidepressants during being pregnant. It could also lead towards enhancing our knowledge of the root mechanisms explaining organizations with such final results. The administration of psychiatric illness during pregnancy is incredibly complex Importantly; the amount of illness can only just end up being approximated by the current presence of a prior medical diagnosis of despair and/or stress and anxiety and healthcare usage (i.e. psychiatrist trips) ahead of pregnancy. As a result while modification for these elements may account to some extent for confounding because of root maternal disease the prospect of residual confounding continues to be. Women that are pregnant who continue their antidepressant therapy throughout pregnancy may differ from those who stop prior to or during the first trimester. It is noted that within both groups of cases and controls only 32 women (7.7%) of 414 continued their antidepressant beyond the first trimester (12 weeks). Palmsten et al. [2] recently exhibited that within prepregnancy antidepressant users the relative risk for pre-eclampsia among continuers compared with discontinuers was 1.32 (95% confidence interval 0.95-1.84) for SSRIs 3.43 (95% confidence interval 1.77-6.65) for serotonin-norepinephrine reuptake inhibitors (SNRIs) and 3.26 (95% confidence interval 1.04-10.24) for tricyclic antidepressant (TCA) monotherapy. These findings either point to a direct effect of antidepressant exposure during the second/third trimester around the risks of gestational hypertension which is usually in line with the proposed biological mechanism Caspofungin Acetate reported [1-3] or they are reflective of differences in underlying disease pathology between continuers and discontinuers and therefore the potential for confounding by maternal illness. We feel that given the above and in particular due to the difficulties Rabbit Polyclonal to BCL-XL (phospho-Thr115). involved in differentiating the underlying effects of maternal depressive disorder from that of antidepressant use current evidence should be viewed cautiously and that it is premature to use this evidence to guide obstetric management of women with depressive disorder during pregnancy. It is important to stress the significance of adequately treating maternal psychiatric illness during pregnancy because this may not only play an important function in the pathogenesis of gestational hypertension but can also be connected with a variety of harmful results on maternal and.