Antidepressants in pregnancy: weighing benefits and risks

Published on March 5, 2012 at 9:18 PM · No Comments

By Dr Ananya Mandal, MD

There has been a debate on the use of antidepressant medication in pregnant women. Depression during pregnancy is, of course, difficult for the woman. In addition, depression that continues in the postpartum period may interfere with caretaking and bonding with the newborn.

The latest on a series of studies on this issue, published Monday in the Archives of General Psychiatry, shows benefits and risks to continuing medication during pregnancy and concludes that more study is needed on the topic. As many as 6% of pregnant women take antidepressants.

To understand the issue the researchers from Netherlands studied 7,696 pregnant women, which included 570 women with depression who were not on medication and 99 women with depression who were being treated with selective serotonin reuptake inhibitors (SSRIs), a common class of antidepressants.

Most of the mothers (7,027, or 91.3%), who had few depressive symptoms and did not use SSRIs, formed the control group. Another 570 mothers (7.4%) had clinically relevant depressive symptoms but did not use SSRIs, while the remaining 99 mothers (1.3%) used SSRIs during pregnancy. Mean depression scores on the depression scale of the Brief Symptom Inventory were 0.10 in the control group, 1.45 in the women with depressive symptoms but no SSRIs, and 0.74 for the women taking SSRIs.

They found that the untreated, depressed women were more likely to have babies with reduced body growth, including reduced fetal head size, while depressed women taking SSRIs were more likely to have babies with reduced fetal head size but a normal fetal body growth. It's unclear how significant reduced fetal head growth is. It has been linked to later behavioral and psychiatric problems in other studies.

Fetal head growth is “one of the best prenatal markers of brain volume,” and reduced head growth has been linked to poor cognitive performance, behavioral problems, and psychiatric disorders later in life. “Nonetheless, we must be careful not to infer an association of SSRI use in pregnancy with future developmental problems. ... [M]ore long-term drug safety studies are needed before evidence-based recommendations can be derived,” the investigators noted.

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