Antidepressant use in pregnancy: a critical review focused on risks and controversies
Version of Record online: 14 DEC 2012
© 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd
Acta Psychiatrica Scandinavica
Volume 127, Issue 2, pages 94–114, February 2013
How to Cite
Antidepressant use in pregnancy: a critical review focused on risks and controversies., , .
- Issue online: 9 JAN 2013
- Version of Record online: 14 DEC 2012
- Manuscript Accepted: 10 OCT 2012
- in utero;
- postnatal adaptation syndrome;
- persistent pulmonary hypertension
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.
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.
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.
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.