Grant: Knowledge Synthesis Grant

Antidepressant Medication; Anxiety; Delivery Outcomes; Infant Outcomes; Knowledge Translation; Maternal Outcomes; Meta-Analysis; Postpartum; Pregnancy; Systematic Review

<html> <body> <p>It has been estimated that up to 1 in 5 women experience anxiety perinatally serious enough for a clinical diagnosis of an anxiety disorder. This project aims to synthesize the effects of perinatal anxiety and its treatments on outcomes for both mother and infant. Not only are perinatal anxiety disorders&nbsp;common, negative outcomes of this exposure have been reported for mother and baby. Both pharmacological and other&nbsp;treatments exist but pharmacological options&nbsp;may be avoided due to safety concerns for the infant. The mainstays of pharmacological treatment for anxiety disorders are selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors,&nbsp;tricyclic antidepressants, benzodiazepines and others&nbsp;as such as buspirone (&ldquo;antianxiety agents&rdquo;). Conflicting research data exist on medication effects in pregnancy, but both Health Canada and the U.S. Federal Drug Administration (FDA) have issued several advisories about potential associated risks.&nbsp;These advisories have contributed to the focus on medication effects for the fetus without consideration for&nbsp;the effects of the psychiatric disorder itself on potential negative outcomes.&nbsp;Both the effects&nbsp;of&nbsp;medication and the disorder&nbsp;must be taken into account when discussing potential treatments in order to make balanced evidence based decisions. Our research team&nbsp;synthesized&nbsp;literature on&nbsp;the effects of antenatal depression and&nbsp;antidepressant medication exposure.&nbsp;This has resulted in several high profile research publications (BMJ, JAMA Psychiatry, Journal of Clinical Psychiatry). We also translated the knowledge for use in a clinical context in the form of a knowledge translation (KT) tool (&ldquo;Physician Reference Guide&rdquo;) that is currently being rolled out for evaluation at general, obstetric and psychiatric practice sites in Ontario to determine its impact on bridging&nbsp;the knowledge to action gap.&nbsp;We now aim to synthesize the independent and synergistic effects of perinatal anxiety and exposure to antianxiety agents.<br> <br>Our&nbsp;team will conduct a comprehensive, up-to-date systematic review/meta-analyses, as they&nbsp;are lacking for perinatal anxiety and antianxiety agents. Due to our&nbsp;previous work,&nbsp;we are in a unique position to carry-out a review for perinatal anxiety as it will be informed and enhanced by our established research methods. Our study team and Advisory Committee&rsquo;s (AC) areas of expertise remain highly relevant to the conduct of the proposed study and specific anxiety content experts have been added. The AC includes representatives from our three primary target audiences (psychiatry, family medicine, and obstetrics), neonatology, public health, biostatistics, patient advocacy and experts in syntheses and medical decision tools.<br> <br>In the short-term, the&nbsp;knowledge synthesis&nbsp;will be translated for clinicians into a summary suitable for dissemination through our AC and research team members using their various networks, through conferences and presentations and submitted for publication. The immediate outcomes will be the provision of evidence for improved patient discussions and clinical decisions. Ultimately, over the long-term, we will incorporate the new syntheses into our KT tool for wide dissemination across Canada. This will further enhance our tool allowing it to be more comprehensive and further fostering evidence based discussions between care providers and patients, leading to improved maternal and child health outcomes for Canadians and contributing to best practices.</p> </body> </html>