Antidepressant use in pregnancy: a critical review focused on risks and controversies
Department of Psychiatry
Antidepressive Agents; Pregnancy; Pregnant Women; Abnormalities, Drug-Induced; Maternal-Fetal Exchange; Teratogens; Persistent Fetal Circulation Syndrome
Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Maternal and Child Health | Obstetrics and Gynecology | Psychiatry | Psychiatry and Psychology | Women's Health
OBJECTIVE: Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations.
METHOD: MEDLINE/PubMed was searched for reports and studies on the risk of first-trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure.
RESULTS: While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association.
CONCLUSION: Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women's preference should guide treatment decisions.
DOI of Published Version
Byatt N, Deligiannidis KM, Freeman MP. Antidepressant use in pregnancy: a critical review focused on risks and controversies. Acta Psychiatr Scand. 2013 Feb;127(2):94-114. doi: 10.1111/acps.12042. Epub 2012 Dec 14. Review. PubMed PMID: 23240634; PubMed Central PMCID: PMC4006272. Link to article on publisher's website
Acta psychiatrica Scandinavica
Byatt N, Deligiannidis KM, Freeman MP. (2013). Antidepressant use in pregnancy: a critical review focused on risks and controversies. Psychiatry Publications. https://doi.org/10.1111/acps.12042. Retrieved from https://escholarship.umassmed.edu/psych_pp/577