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Objective-Selective serotonin reuptake inhibitor (SSRI) use during pregnancy incurs a low absolute risk for major malformations; however, other adverse outcomes have been reported. Major depression also affects reproductive outcomes. This study examined whether 1) minor physical anomalies, 2) maternal weight gain and infant birth weight, 3) preterm birth, and 4) neonatal adaptation are affected by SSRI or depression exposure.Method-This prospective observational investigation included maternal assessments at 20, 30, and 36 weeks of gestation. Neonatal outcomes were obtained by blinded review of delivery records and infant examinations. Pregnant women (N=238) were categorized into three mutually exclusive exposure groups: 1) no SSRI, no depression (N=131); 2) SSRI exposure (N=71), either continuous (N=48) or partial (N=23); and 3) major depressive disorder (N=36), either continuous (N=14) or partial (N=22). The mean depressive symptom level of the group with continuous depression and no SSRI exposure was significantly greater than for all other groups, demonstrating the expected treatment effect of SSRIs. Main outcomes were minor physical anomalies, maternal weight gain, infant birth weight, pregnancy duration, and neonatal characteristics.Results-Infants exposed to either SSRIs or depression continuously across gestation were more likely to be born preterm than infants with partial or no exposure. Neither SSRI nor depression exposure increased risk for minor physical anomalies or reduced maternal weight gain. Mean HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript infant birth weights were equivalent. Other neonatal outcomes were similar, except 5-minute Apgar scores.Conclusions-For depressed pregnant women, both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%.The prevalence of major depressive disorder in women is highest during the childbearing years (1). Maternal depression is associated with perinatal risk related to physiological sequelae of the disorder and maternal behaviors, such as smoking, substance abuse, and inadequate obstetrical care. Selective serotonin reuptake inhibitor (SSRI) antidepressant therapy is common among childbearing-aged women, with 2.3% of pregnant women per year exposed (2).Although the majority of early reports (3-7) of SSRI treatment during pregnancy did not identify an increased risk for birth defects, in 2005 the Food and Drug Administration (FDA) issued an advisory indicating that early exposure to paroxetine may increase the risk for cardiac defects (http://www.fda.gov/CDER/Drug/advisory/paroxetine200512.htm). In response, two large-scale case-control studies were published (8, 9). Overall, SSRI exposure was not associated with congenital heart problems or the majority of other categories of birth defects in either investigation. The authors (8, 9) and Greene (10) concluded that SSRI exposure is associated with a small absolute risk (if any) for major defects.Fi...

Objective-Selective serotonin reuptake inhibitor (SSRI) use during pregnancy incurs a low absolute risk for major malformations; however, other adverse outcomes have been reported. Major depression also affects reproductive outcomes. This study examined whether 1) minor physical anomalies, 2) maternal weight gain and infant birth weight, 3) preterm birth, and 4) neonatal adaptation are affected by SSRI or depression exposure.Method-This prospective observational investigation included maternal assessments at 20, 30, and 36 weeks of gestation. Neonatal outcomes were obtained by blinded review of delivery records and infant examinations. Pregnant women (N=238) were categorized into three mutually exclusive exposure groups: 1) no SSRI, no depression (N=131); 2) SSRI exposure (N=71), either continuous (N=48) or partial (N=23); and 3) major depressive disorder (N=36), either continuous (N=14) or partial (N=22). The mean depressive symptom level of the group with continuous depression and no SSRI exposure was significantly greater than for all other groups, demonstrating the expected treatment effect of SSRIs. Main outcomes were minor physical anomalies, maternal weight gain, infant birth weight, pregnancy duration, and neonatal characteristics.Results-Infants exposed to either SSRIs or depression continuously across gestation were more likely to be born preterm than infants with partial or no exposure. Neither SSRI nor depression exposure increased risk for minor physical anomalies or reduced maternal weight gain. Mean HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript infant birth weights were equivalent. Other neonatal outcomes were similar, except 5-minute Apgar scores.Conclusions-For depressed pregnant women, both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%.The prevalence of major depressive disorder in women is highest during the childbearing years (1). Maternal depression is associated with perinatal risk related to physiological sequelae of the disorder and maternal behaviors, such as smoking, substance abuse, and inadequate obstetrical care. Selective serotonin reuptake inhibitor (SSRI) antidepressant therapy is common among childbearing-aged women, with 2.3% of pregnant women per year exposed (2).Although the majority of early reports (3-7) of SSRI treatment during pregnancy did not identify an increased risk for birth defects, in 2005 the Food and Drug Administration (FDA) issued an advisory indicating that early exposure to paroxetine may increase the risk for cardiac defects (http://www.fda.gov/CDER/Drug/advisory/paroxetine200512.htm). In response, two large-scale case-control studies were published (8, 9). Overall, SSRI exposure was not associated with congenital heart problems or the majority of other categories of birth defects in either investigation. The authors (8, 9) and Greene (10) concluded that SSRI exposure is associated with a small absolute risk (if any) for major defects.Fi...

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The writing scaffold is recommended for use by nursing faculty to facilitate the development of scholarly writing abilities within nursing, across nursing program levels, and across disciplines.