Delivery Outcome in Relation to Maternal Use of Some Recently Introduced Antidepressants

Abstract

Little is known concerning possible hazards of maternal use of the recently introduced antidepressant drugs with noradrenergic and varying serotonergic activity (serotonin-noradrenaline reuptake inhibitor [SNRI]/noradrenergic reuptake inhibitor [NRI] drugs). Using the Swedish Medical Birth Registry, we identified 732 women who had used SNRI/NRI drugs in early pregnancy. Maternal characteristics were studied as well as delivery outcome: pregnancy duration, birth weight, neonatal diagnoses, infant deaths, and congenital malformations. Comparisons were made with all deliveries in the population (n = 860,215) after adjustment for identified confounders, and risks were expressed as odds ratios or (when numbers were low) as risk ratios. Women using SNRI/NRI deviated from other women by being older, more often having their first infant, being more extensive smokers, having a higher body mass index, and more often being born within Sweden. These characteristics, like the pattern of concomitant drug use, resembled much those of women using selective serotonin reuptake inhibitor (SSRI) drugs. The rate of preterm births was significantly increased (odds ratio, 1.6; 95% confidence interval, 1.19-2.15), and neonatal symptoms such as respiratory problems, low Apgar score, hypoglycemia, and neonatal convulsions showed a similar pattern as seen after maternal SSRI treatment. We found no increased risk for stillbirths or congenital malformations. Delivery outcome after exposure to SNRI/NRI drugs resembles much what has been described after use of SSRI drugs. No signs of teratogenicity were found.

Treatment Considerations for Patients With Neuropathic Pain and Other Medical Comorbidities

“…56 Two studies of venlafaxine (with 732 and 150 patients) observed no increased risk of birth defects. 57,58 If medication is needed during pregnancy, preconception planning is ideal. Folic acid supplementation is recommended before conception and during pregnancy for mothers using certain antiepileptics (eg, carbamazepine) to decrease the risk of neural tube defects.…”

Cardiac dysfunction and prenatal exposure to venlafaxine

“…With respect to the recently introduced antidepressants like SNRIs, several published studies found similar outcomes to those described with the use of other antidepressant categories 3, 10, 11, 12. However, it has been pointed that only a severe teratogenic effect could have been detected with the available data on these more recent antidepressants 12.…”

Treatment of Depression During Pregnancy and the Postpartum Period

“…41,52,69,83,86,111,119,122,128,133,135 Only five of these studies that used ultrasound to determine gestational age, 111,119,128,133,135 four of which reported odds ratios adjusted for confounding factors. These studies did not find an increased risk of an infant being small for gestational age (adjusted pooled OR of 1.04 , 95% CI, 0.64 to 1.69; I 2 =30%) with SSRI use during pregnancy.…”

“…42,45,49,53,64,90,111,112,122,128,133,146 Based on eleven observational studies, there is evidence of an increased risk of preterm birth (< 37 weeks gestation) and that the magnitude of risk may vary by timing of exposure, but current evidence is inadequate to establish reliable estimates. The most relevant of these studies is a medium risk of bias study that reported a statistically significant increased risk of preterm birth with SSRI use during pregnancy for any reason, compared with pregnant women with a documented psychiatric illness who did not receive an SSRI (or other antidepressant or antipsychotic drug) during pregnancy; adjusted OR 2.68 (95% CI, 1.83 to 3.93), 128 While this study did not limit the diagnoses to depression, gestational age was determined by ultrasound.…”

“…90,111,112,128 These studies performed ultrasound verification of gestational age, defined preterm birth as delivery at less than 37 weeks gestation and found an increased risk of preterm birth. A single study found the risk with early exposure to be extremely increased, adjusted OR of 11.7 (95% CI, 2.20 to 60.70); and a second study found increased risk with late exposure, adjusted OR 2.48 (95% CI, 1.75 to 3.50).…”