Women's Health

Antidepressant use during pregnancy is linked to increases in preterm birth and potentially serious infant perinatal problems

From 10 to 20 percent of pregnant women suffer from depression. Since depression's impact on both the mother and developing fetus can be profound, treating moderate to severe depression with antidepressants during pregnancy is generally recommended. However, a new study warns about increases in preterm deliveries and newborn disorders in infants whose mothers took antidepressants. Whether these risks were due to the antidepressants, the underlying depression, or other factors such as smoking could not be determined in this study.

In this study, infants exposed to the newer selective serotonin reuptake inhibitors (SSRIs) or the older tricyclic antidepressants (TCAs) during pregnancy had a significant increase in preterm delivery. Also, full-term infants exposed to SSRIs during the third trimester had a higher risk of respiratory distress syndrome, endocrine and metabolic disturbances, low blood-sugar levels, temperature regulation disorders, and convulsions. Infants exposed to TCAs during the third trimester also had an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, and temperature regulation disorders.

Neither SSRIs nor TCAs were associated with an increased risk for congenital anomalies. Six percent of infants exposed in utero to SSRIs and 8 percent exposed to TCAs had feeding problems; approximately 0.7 percent of infants exposed in utero to either SSRIs or TCAs had convulsions.

Investigators at the HMO Research Network's Center for Education and Research in Therapeutics identified 2,201 women who were prescribed an antidepressant during pregnancy and who delivered an infant within 1 of 5 large managed care organizations. They analyzed the HMO databases to examine the association between use of TCAs and SSRIs by trimester with rates of congenital anomalies or perinatal complications compared with infants of mothers who were not prescribed antidepressants during pregnancy. The study was supported in part by the Agency for Healthcare Research and Quality (HS10391).

More details are in "Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy," by Robert L. Davis, M.D., M.P.H., David Rubanowice, B.S., Heather McPhillips, M.D., M.P.H., and others, in Pharmacoepidemiology and Drug Safety 16, pp. 1086-1094, 2007.

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