Untreated major depression, as well as the use of antidepressant medications,
may increase the risk for premature (preterm) birth, but the risk of other
problems in fetuses such as breathing, gastrointestinal, or motor problems, may
not be increased, according to a study of pregnant women published online ahead
of print in the American Journal of Psychiatry.
Background
Use of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs),
is common among women of childbearing age. Although there is some concern
regarding the use of SSRIs during pregnancy and their effects on the growing
fetus, research results have been mixed. Overall, it appears the risk for major
birth defects is very low, but the risk for other complications, such as minor
physical anomalies—a specific type of birth defect—or preterm birth (before 37
weeks gestation), has not been consistently established.
Katherine L. Wisner, M.D., of the University of Pittsburgh, and colleagues aimed
to determine whether the use of SSRIs or the existence of major depression
during pregnancy was associated with minor physical anomalies in the baby, low
infant birth weight, preterm birth or other issues. In this observational study,
the researchers categorized 238 pregnant women in Cleveland, Ohio, and
Pittsburgh, Pa., into one of three groups:
* no use of SSRIs and no major depression during pregnancy (131 women);
* use of SSRIs either at some point (23 women) or throughout the pregnancy (48
women);
* those who had major depression—either at some point (22 women) or throughout
the pregnancy (14 women)—but who remained unmedicated.
The researchers gave general advice to the women about managing major depression
and use of SSRIs, but they did not interfere in treatment decisions made by the
women and their doctors. Wisner and colleagues examined various outcomes, such
as maternal weight gain, pregnancy duration, minor physical anomalies in the
infant, infant birth weight, and other infant characteristics.
Results of the Study
Wisner and colleagues found that for both pregnant women with untreated major
depression and for those who were taking SSRIs throughout their pregnancy, more
than 20 percent of infants were delivered preterm. In comparison, only 4 percent
of infants partially exposed to SSRIs during gestation and 6 percent not exposed
at all to SSRIs or depression during gestation were delivered pre-term.
Neither the use of SSRIs nor major depression was associated with an increase in
minor physical anomalies; short-term medication-associated issues like
breathing, gastrointestinal or motor problems; or reduced weight gain among the
women during pregnancy. Birth weight of infants also did not differ across
groups.
Significance
The results support other studies that have found a link between continuous SSRI
treatment and an increase in risk of preterm birth, but they are not consistent
with studies that have found an increased risk of drug-associated issues in
infants exposed to SSRIs while in the womb. However, the researchers note that
untreated depression among pregnant women may present the same risk to infants
as SSRI use, reiterating the need for doctors to work with individual patients
to balance the risks and benefits of SSRI use and the treatment of major
depression during pregnancy.
What's Next
More research is needed to better determine whether women with major depression
who are treated with SSRIs and experience remission during pregnancy have more
favorable outcomes compared to unmedicated depressed women. In addition, larger
studies may be able to determine differences in outcomes among SSRIs. Finally,
more research into non-medication interventions for treating depression during
pregnancy, including psychotherapy and other approaches, is also needed.
Source: National Institute Of Mental Health
