Antidepressant use in pregnancy: a critical review focused on risks and controversies

Authors

  • N. Byatt,

    Corresponding author
    • Psychiatry and Obstetrics & Gynecology, Psychosomatic Medicine, Women's Mental Health, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, USA
    Search for more papers by this author
  • K. M. Deligiannidis,

    1. Psychiatry and Obstetrics & Gynecology, Depression Specialty Clinic, Women's Mental Health Specialty Clinic, Center for Psychopharmacologic Research and Treatment, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA, USA
    Search for more papers by this author
  • M. P. Freeman

    1. Psychiatry, Perinatal and Reproductive Psychiatry Program, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
    Search for more papers by this author

Nancy Byatt, Psychiatry and Obstetrics & Gynecology, Psychosomatic Medicine, Women's Mental Health, University of Massachusetts Medical School/UMass Memorial Medical Center, 55 Lake Avenue North, Worcester, MA 01655, USA.

E-mail: nancy.byatt@umassmemorial.org

Abstract

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.

Ancillary