N Byatt1, K M Deligiannidis, M P Freeman. 1. Psychiatry and Obstetrics & Gynecology, Psychosomatic Medicine, Women's Mental Health, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA 01655, USA. 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.
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.
Authors: Susan E Andrade; Heather McPhillips; David Loren; Marsha A Raebel; Kimberly Lane; James Livingston; Denise M Boudreau; David H Smith; Robert L Davis; Mary E Willy; Richard Platt Journal: Pharmacoepidemiol Drug Saf Date: 2009-03 Impact factor: 2.890
Authors: Victoria Hendrick; Lynne M Smith; Rita Suri; Sun Hwang; Desiree Haynes; Lori Altshuler Journal: Am J Obstet Gynecol Date: 2003-03 Impact factor: 8.661
Authors: Tze-Ern Chua; John Carson Allen; Loretta Ang; Li Lian Ong; Ying Chia Ch'ng; Helen Chen Journal: Singapore Med J Date: 2016-06-01 Impact factor: 1.858