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To the Editor: The pharmacologic treatment of depression during pregnancy presents a therapeutic dilemma for physicians. Prospective data are sparse and decisions regarding which agents to prescribe are made based on retrospective reviews and anecdotal reports. The review by Dr Wisner and colleagues1 of the pharmacologic treatment of depression during pregnancy is a welcome synthesis based on prospective data regarding pregnancy outcomes for women treated with antidepressants. However, their discussion of pharmacologic agents used in the treatment of depression is limited.
Wisner et al based their review on only 4 studies, all of which relate to the use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) during pregnancy. Other agents are briefly mentioned, but the authors state that prospective data are lacking. However, bupropion has had a pregnancy registry in place since September 1997.2 This registry follows bupropion exposures prospectively and accepts retrospective reports of anomalies and adverse events. As of February 1999, 30 pregnancies exposed to bupropion have been registered, with 12 outcomes documented thus far.2 This is particularly relevant information for the clinician, since bupropion has a manufacturer determined pregnancy rating of B, which may make it appear safer to use in pregnancy. Additionally, data are available on 100 pregnancy outcomes of patients who received trazodone during the first trimester.3 Finally, there is limited information on the pregnancy outcomes of patients treated with venlafaxine during the first trimester.4 Although these sources of information did not meet the authors' criteria for inclusion for review, they should have been briefly discussed for completeness.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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