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Davis, R. L. et al. Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy. Pharmacoepidemiol. Drug Saf. 16, 1086-1094

Center for Health Studies, Group Health Cooperative, Seattle, WA, USA.
Pharmacoepidemiology and Drug Safety (Impact Factor: 3.17). 10/2007; 16(10):1086-94. DOI: 10.1002/pds.1462
Source: PubMed

ABSTRACT To evaluate risks for perinatal complications and congenital defects among infants exposed in utero to antidepressants.
We identified 2201 women who were prescribed an antidepressant during pregnancy and who delivered an infant within one of five large managed care organizations (HMO). Prescription drug dispensings and inpatient and outpatient diagnoses were obtained from automated databases at each HMO. Antidepressants were categorized into tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and medication timing was assessed by trimester. Rates of congenital anomalies or perinatal complications were compared to infants whose mothers were not prescribed antidepressants during pregnancy.
Infants exposed to SSRIs or TCAs during pregnancy had a significant increase in preterm delivery risk. Fullterm infants exposed to SSRIs during the third trimester had an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, hypoglycemia, temperature regulation disorders, and convulsions. Third-trimester exposure to TCAs was also associated with an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, and temperature regulation disorders. There were 182 infants exposed to Paroxetine, and these infants did not have an increased risk of cardiac septal defects.
SSRIs and TCAs did not show a consistent link with congenital anomalies. Paroxetine exposure was not linked with an increased risk for cardiovascular anomalies, although our study power to detect a moderate increase in risk was limited. Infants exposed to antidepressants were at increased risk for preterm delivery. Both SSRIs and TCAs used during the third trimester appeared to increase the risk for perinatal complications and their use should be managed carefully among pregnant women with depression.

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    • "However, not all studies are in agreement,89,90,92,100,166,167 and one study even documented a reduced risk of spontaneous preterm birth associated with medication treatment of depressive symptoms during pregnancy, although the main exposure group included both sedative medications and antidepressants.32 Most studies to date have focused on antenatal SSRI use; however, an increased risk of preterm delivery has also been reported for TCAs, venlafaxine, and mirtazapine.97,127,128 "
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    ABSTRACT: In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.
    Drug, Healthcare and Patient Safety 09/2014; 6:109-29. DOI:10.2147/DHPS.S43308
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    • "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) 8 No Pearson [31] 2007 Various AD Nondepressed Retrospective 252 1.07 (0.4–2.67) 4 No Suri [32] 2007 Various AD Depressed Prospective 71 3.5 (0.4–165.11) 11 Yes Djulus [33] 2006 Mirtazapine Nondepressed Prospective 208 5.43 (1.11–51.83) "
    General hospital psychiatry 01/2014; 36(3). DOI:10.1016/j.genhosppsych.2014.01.005 · 2.90 Impact Factor
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    • "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) 8 No Pearson [31] 2007 Various AD Nondepressed Retrospective 252 1.07 (0.4–2.67) 4 No Suri [32] 2007 Various AD Depressed Prospective 71 3.5 (0.4–165.11) 11 Yes Djulus [33] 2006 Mirtazapine Nondepressed Prospective 208 5.43 (1.11–51.83) "
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    ABSTRACT: To examine the relationship between antidepressant use in pregnancy and low birth weight (LBW) and preterm birth (PTB). We searched English and non-English language articles via PubMed, CINAHL and PsychINFO (from their start dates through December 1st, 2012). We used the following keywords and their combinations: antidepressant, selective serotonin reuptake inhibitor (SSRI), pregnancy, antenatal, prenatal, birthweight, birth weight, preterm, prematurity, gestational age, fetal growth restriction, intrauterine growth restriction, and small-for-gestational age. Published studies were considered eligible if they examined exposure to antidepressant medication use during pregnancy and reported data on at least one birth outcome of interest: PTB (<37 weeks gestation) or LBW (<2500 g). Of the 222 reviewed studies, 28 published studies met the selection criteria. Two authors independently extracted study characteristics from eligible studies. Using random-effects models, antidepressant use in pregnancy was significantly associated with LBW (RR: 1.44, 95% confidence interval (CI): 1.21-1.70) and PTB (RR: 1.69, 95% CI: 1.52-1.88). Studies varied widely in design, populations, control groups and methods. There was a high level of heterogeneity as measured by I2 statistics for both outcomes examined. The relationship between antidepressant exposure in pregnancy and adverse birth outcomes did not differ significantly when taking into account drug type (SSRI vs. other or mixed) or study design (prospective vs. retrospective). There was a significant association between antidepressant exposure and PTB for different types of control status used (depressed, mixed or nondepressed). Antidepressant use during pregnancy significantly increases the risk for LBW and PTB.
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