antidepressants in pregnancyA series of three recent studies into the side-effects of antidepressant use during pregnancy has found no clear effects on the baby but a possible risk of hemorrhage during childbirth.

Depression is common in pregnancy and afterwards, with a rate of 11% to 20% in the United States. Antidepressants are being increasingly used, so a large body of research has examined the potential risks.

The first study, led by Dr. Marte Handal of the Norwegian Institute of Public Health, included details on 51,404 children. Among the mothers, 159 used selective serotonin reuptake inhibitors (SSRIs) during pregnancy.

At three years old, the children in this group showed “a slight delay in the development of fine and gross motor skills,” but the study is limited by small the numbers. Dr. Handal, stated, “Our results show that treatment with SSRIs during longer time periods in pregnancy was weakly associated with a delayed motor development at age three. However, only a very small number of children had a severe delay. Even though we did take into account maternal symptoms of depression we still did not have complete information on the severity of the maternal depression in the different groups.

“Effective treatment of depression during pregnancy is essential and these results should not discourage healthcare professionals from prescribing or continuing antidepressant treatment to those who need it.”

In the second study, information from 49,000 women in Australia was analyzed. This indicated that, while untreated prenatal depression in the mother was linked to an increased risk of problem behavior in the children (hyperactivity, inattention, and peer problems) at age seven, there was no raised risk when the mother took antidepressants.

The last study was carried out by the same team. Dr. Luke Grzeskowiak and colleagues at The University of Adelaide, Australia, analyzed figures on 29,850 women. This showed the rate of postpartum hemorrhage (loss of 500 to 1,000ml of blood in the first 24 hours) was 16% if the woman had taken antidepressants in the last trimester, compared with 11% if she had not.

“It is reassuring to find that prenatal exposure to antidepressants did not affect a child’s behavior at age seven, however as with any medication, the benefits and risks must always be considered,” Dr. Grzeskowiak said. “Regarding our other study, overall the risks for postpartum hemorrhage are largely unknown. We found separate increases in risk with placenta praevia, prolonged labor, hypertension and assisted vaginal delivery, as well as the increased risk seen with antidepressant use. However we did not have data on known risks such as use of oxytocin during delivery, nor did we have any data on the severity of the underlying maternal psychiatric illness.

“Consequently, it is possible that the women who took antidepressants late in pregnancy were those with the most severe illness and it is this which is responsible for the increased risk of postpartum hemorrhage and not the antidepressant. Based on this study alone we do not recommend that women stop taking medication for depression during pregnancy, but are closely monitored in order to reduce the risk of any potential increased risk of bleeding as much as possible.”

All are published in BJOG: An International Journal of Obstetrics and Gynaecology. Dr. Patrick O’Brien of the Royal College of Obstetricians and Gynaecologists commented, “The decision whether or not to use SSRIs during pregnancy must be considered on an individual basis as untreated maternal depression can itself be harmful. Pregnant women and mothers can be reassured from these studies which suggest there are no clinically important long term neurodevelopmental or behavioral problems associated with taking SSRIs.

“While it is useful for women to be aware that SSRI use may increase the risk of postpartum hemorrhage, more research needs to be done to understand what is behind this increased risk. Women should not stop taking their medication without first discussing their options with their doctor and if necessary extra precautions can be taken to prevent postpartum hemorrhage at the time of birth.”

Overall, these new studies make an important contribution to the evidence on antidepressant use during pregnancy. Great caution should be used before initiating or continuing antidepressant treatment for pregnant women, but the research generally supports the use of SSRIs in pregnancy, as any minimal risks from treatment are typically outweighed by the potential risks of untreated depression.

 

References

Handal, M. et al. Motor development in children prenatally exposed to selective serotonin reuptake inhibitors: a large population-based pregnancy cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 16 September 2015 doi: 10.1111/1471-0528.13582

Grzeskowiak, L. E. et al. Prenatal Antidepressant Exposure and Child Behavioural Outcomes at 7-Years of Age: A study within the Danish National Birth Cohort. BJOG: An International Journal of Obstetrics and Gynaecology, 16 September 2015 doi: 10.1111/1471-0528.13611

Grzeskowiak, L. E. et al. Antidepressant use in late gestation and risk of postpartum hemorrhage: a retrospective cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 16 September 2015 doi: 10.1111/1471-0528.13612

Pregnancy photo available from Shutterstock