Antidepressant Use in Pregnant and Postpartum Women

Abstract

Women in their reproductive years are at increased risk of experiencing depressive and anxiety disorders. As such, it is likely that pregnant women will undergo treatment with antidepressants. We review the risk of adverse pregnancy outcomes and perinatal and neonatal complications of the offspring related to in utero exposure to antidepressants. The literature shows that antidepressant exposure is associated with fetal growth changes and shorter gestations, although effects are small. There are a number of reports of transitory neonatal signs after exposure to antidepressants. No specific pattern of malformations has been consistently associated with antidepressants, with the possible exception of paroxetine and cardiac malformations. There is inconclusive evidence of a link between antidepressants in late pregnancy and persistent pulmonary hypertension in the newborn. While antidepressant use in pregnancy is well studied, confounding factors that can adversely affect pregnancy and birth outcomes may contribute to some of the findings.

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

“…27,28,32 Although there are conflicting reports published, a greater number of studies on the use of paroxetine describe deleterious effects such as increased risk of cardiac malformations. 24,[26][27][28]31,[33][34][35] This increased risk is also supported by two recent meta-analyses (reported OR = 1.43, 95%CI 1.08-1.88 and 1.44, 95%CI 1.12-1.86). 27,28 The OR for the same defects in fluoxetine users was reported to be 1.17-1.60 by three meta-analyses.…”

“…48,49,64 Data are also conflicting regarding the relationship between antenatal antidepressant exposure and other neonatal outcomes such as spontaneous abortion, birth weight, persistent pulmonary hypertension, and autism spectrum disorders. 23,26,35,47,[50][51][52][53][54][55][56][57]60,[65][66][67][68][69] Specific information on the risk of other neonatal outcomes in fetuses exposed to clomipramine is lacking. The limited available data suggest that similar to SSRIs, TCAs may be associated with PTB and PNAS.…”

“…30,91 However, two SSRIs including fluoxetine and particularly paroxetine are not appropriate for first-line treatment because these drugs are the most frequently associated with congenital malformations and PNAS. 27,28,35,45,95 Nonetheless, these antidepressants may be chosen in women with OCD who do not respond or cannot tolerate other SSRIs due to low elevation of absolute risk of birth defects. 27,28,96,97 Sertraline and citalopram/escitalopram seem to be a more favorable option in the pregnancy period.…”

“…91 Several studies have suggested an approximately 2-fold increased risk of cardiovascular defects associated with clomipramine, although these studies have some methodological limitations. [31][32][33][34][35][36][37][38][39][40] Although this is a discouraging factor in the use of this drug, the absolute risk of cardiovascular defects is still low. In addition, clomipramine is related to higher risk of PNAS compared to other TCAs.…”

Beneficial and harmful consequences of prepartum and postpartum antidepressant exposure: Table 1

“…However, in terms of major malformations, no specific pattern has been consistently associated with ADs, with the possible exception of paroxetine and cardiac malformations 18. It is generally reported that AD exposure may be associated with a significant increased risk of spontaneous abortion, preterm birth and infants born weighing less than 2500 g 17 19…”