Antidepressant Use in Pregnancy May Affect Baby
By Deborah Brauser
Medscape Medical News
March 13, 2013 -- Babies of moms who take antidepressants have a slightly higher risk of being born preterm and other problems. But the risk to the mom and baby of stopping antidepressants may outweigh the risks of using them, new research suggests.
The research, an analysis of 23 studies, shows that being exposed to antidepressants while in the womb is linked to preterm delivery, shorter gestational age, and lower Apgar scores (a test used to check the health of the baby right after birth) compared with babies who were unexposed.
However, "group differences were small," the researchers write.
Compared with their healthy peers, moms who took antidepressants during pregnancy were also at risk for babies with lower birth weight.
The researchers note that significant links were found for all of these outcomes. But because the effects were so small, significance of these risks is "questionable."
The study is published in the journal JAMA Psychiatry.
According to the researchers, 12.8% of women have depression during their second trimester of pregnancy, and 12% have it during their third trimester.
"Untreated depression during pregnancy or post-partum has been associated with increased [harm and death] in the mother and her children," write the researchers.
"Despite this, there is evidence that depression is markedly undetected and undertreated during pregnancy."
The researchers examined 23 studies that looked at antidepressant treatments during pregnancy, including older antidepressants and SSRIs, which are more commonly used today.
The results show that infants who were exposed to antidepressants in the womb had a shorter gestational age (about three days shorter), had a lower Apgar score, and were more likely to undergo a preterm delivery than babies who were unexposed.
Nevertheless, "in light of established risks associated with untreated prenatal depression for both mother and infant, the clinical relevance of these increased risks should be interpreted with caution," write the researchers.
How Big a Risk?
"I think this was a very high-quality [study], and they took great care in accounting for a lot of different issues," says Katrina C. Johnson, PhD, assistant professor of psychiatry at Emory University in Atlanta.
"A couple of things stood out in terms of its implications. First, less than 12% of the identified studies appropriately accounted for maternal depression, which is a known risk factor for birth complications. So with so few studies to go on, it leaves both researchers and clinicians in a tight spot with regard to interpreting the effects of antidepressant medications."
She says the authors also made an important distinction between statistical and practical significance.
"For example, for gestational age, exposed babies were born significantly earlier, but only by about half a week. So on average for most of these outcomes, antidepressant-exposed babies were still within normal limits," she says.
Johnson says that moms-to-be with a history of depression should not stop their medication, but should instead talk with their doctor about it.
"Too often you see women who find out they're pregnant and either on their own or on the advice of a physician suddenly stop all psychiatric medications. And this puts both the mother and the baby at risk, especially if it's a sudden stop," she says.
"I think a much better scenario is for a woman to see a psychiatrist, someone experienced in treating peri-partum mood and anxiety disorders and preferably prior to conception, so that they can work together to implement the right treatment for that particular patient. That's better than having a knee-jerk reaction to some of these studies," she says.
To see a version of this story for physicians, visit Medscape, the leading site for physicians and health care professionals.
Ross, L. JAMA Psychiatry, published online Feb. 27, 2013.
Katrina C. Johnson, PhD, assistant professor of psychiatry, Emory University, Atlanta.
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