Major Depression and Antidepressant Treatment: Impact on Pregnancy and Neonatal Outcomes

Abstract

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...

Perceptions and experiences of interventions to prevent postnatal depression. A systematic review and qualitative evidence synthesis

“…Research has established that pregnant women prefer nonpharmacological interventions and are reluctant to take medication because of fear of affecting their developing baby (Wisner et al, 2009) hence the importance of the availability of alternative, non-invasive, interventions for the prevention of PND. In contrast, little is known in general about the views and experiences of women taking part in preventive interventions and what the health care professionals delivering the interventions believe.…”

Obstetric and perinatal outcomes among women with blood- and injection phobia during pregnancy

“…Maternal stress due to psychopathological factors such as depression and anxiety during pregnancy may constitute a risk for adverse pregnancy and perinatal outcomes (Alder et al, 2007;Li et al, 2009;Lou et al, 1994;O´Connor et al, 2002;Rodriguez and Bohlin, 2005). A recent study by Wisner concluded that continuous untreated depression in pregnant women was associated with preterm birth rates exceeding 20 % (Wisner et al, 2009). Emerging research has also demonstrated that maternal stress during pregnancy can result in changes in the hypothalamic-pituitary-adrenal (HPA) axis and elevated levels of stress hormones (particularly cortisol) with premature labor, shortened pregnancy length, low birth weight and impaired fetal brain development as a consequence (Copper et al, 1996;Diego et al, 2006;Field et al, 2006;Gitau et al, 1998;Obel et al, 2005;Sandman et al, 1994;Wadhwa et al, 1993;Weinstock, 2005).…”

Antenatal Exposure to Selective Serotonin Reuptake Inhibitors and Duration of Gestation

“…In one study 6 that compared SSRI-treated women with untreated depressed controls, there was no increase in risk. In the only study to date that described propensity-matching as a method to control for the presence and severity of maternal depression, Oberlander et al 18 found that both the duration of gestation and the risk of preterm delivery did not differ significantly between depressed women who had used SSRIs during pregnancy and those who had not.…”

“…Some, [1][2][3][4][5][6][7][8][9][10] but not all, [11][12][13][14][15][16][17] studies suggest that the use of SSRIs during pregnancy increases the risk of preterm delivery; in the positive studies, the risk appears to be approximately doubled, on average, in SSRIexposed relative to unexposed women. An important limitation of these studies is that all were observational in design.…”