Article

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

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
American Journal of Psychiatry (Impact Factor: 13.56). 04/2009; 166(5):557-66. DOI: 10.1176/appi.ajp.2008.08081170
Source: PubMed

ABSTRACT 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.
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.
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 infant birth weights were equivalent. Other neonatal outcomes were similar, except 5-minute Apgar scores.
For depressed pregnant women, both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%.

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    • "6 No Lund [25] 2009 SSRI Nondepressed Prospective 52099 0.63 (0.15–2.67) 2.02 (1.29–3.16) 7 No Toh [26] 2009 SSRI Mixed Retrospective 5796 1.27 (0.59–2.76) 8 No Wisner [27] 2009 SSRI Nondepressed Prospective 179 5.43 (1.98–14.84) 9 No Maschi [28] 2008 Various AD Mixed Prospective 1400 1.18 (0.53–2.41) 2.31 (1.14–4.63) 3 No Davis [29] 2007 SSRI Mixed Retrospective 50710 1.45 (1.25–1.68) 3 No Lennestal [30] 2007 SNRI Mixed Retrospective 860215 1.12 (0.74–1.68) 1.6 (1.19–2.15) "
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    • "They are considered the primary treatment, or important adjuncts, for moderate to severe depression (Bauer et al. 2002; Davidson 2010; Lam et al. 2009) and other indications (Canadian Psychiatric Association 2006; Ipser and Stein 2012; Kroenke et al. 2009), although their effectiveness and safety in the context of pregnancy have been seldom studied (Yonkers et al. 2009). In pregnant women with depression, antidepressants have been shown to reduce depressive symptoms and improve maternal functioning (Wisner et al. 2009a), while antidepressant discontinuation has been associated with increased risk of antenatal depressive relapses in some (Cohen et al. 2006) but not all studies (Yonkers et al. 2011). For several years, selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed antidepressants (Olfson and Marcus 2009), were regarded as safe for use in pregnancy (Koren and Nordeng 2012). "
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    • "6 No Lund [25] 2009 SSRI Nondepressed Prospective 52099 0.63 (0.15–2.67) 2.02 (1.29–3.16) 7 No Toh [26] 2009 SSRI Mixed Retrospective 5796 1.27 (0.59–2.76) 8 No Wisner [27] 2009 SSRI Nondepressed Prospective 179 5.43 (1.98–14.84) 9 No Maschi [28] 2008 Various AD Mixed Prospective 1400 1.18 (0.53–2.41) 2.31 (1.14–4.63) 3 No Davis [29] 2007 SSRI Mixed Retrospective 50710 1.45 (1.25–1.68) 3 No Lennestal [30] 2007 SNRI Mixed Retrospective 860215 1.12 (0.74–1.68) 1.6 (1.19–2.15) "
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