Anti-Depressant Use During Pregnancy and Birth Outcomes

Author:
Brittany Perry, DO
Nemours/Alfred I. duPont Hospital for Children

Citation:
Perry B. Anti-depressant use during pregnancy and birth outcomes. Published online July 28, 2020. Consultant360.

Bandoli G, Chambers CD, Wells A, Palmsten K. Prenatal antidepressant use and risk of adverse neonatal outcomes. Pediatrics. 2020;146(1):e20192493. https://doi.org/10.1542/peds.2019-2493

The emotional well-being of a pregnant woman plays a critical role in the health of her developing baby. Depression affects about 10% of women during pregnancy, and when untreated, depression can lead to poor outcomes for both mother and child. Many women will consider pharmacologic treatment for depression during pregnancy and may want to discuss the benefits and risks of medication use with their provider. 

Bandoli and colleagues published a retrospective study comparing pregnant women with anxiety and depression who took no antidepressant medication during pregnancy, women who took antidepressant medication, and all other pregnancies.

The researchers divided antidepressant use into the following groups: low initial use at 10 mg/d with reduction or discontinuation during the first trimester, moderate initial use (~40 mg/d) with reduction or discontinuation during the first trimester, low sustained use (~20 mg/d), moderate sustained use (~40 mg/d), and high sustained use (~75 mg/d).

The primary outcomes assessed were risk of preterm birth, newborn respiratory distress, and cardiac malformations. Compared with the low dose antidepressant group with reduction or discontinuation in the first trimester, all other medication groups had a dose-dependent increased risk for neonatal respiratory distress.

Women who used moderate to high doses of antidepressants sustained through pregnancy had higher risk of preterm birth, though disease severity was a confounding factor. There was no association between antidepressants and cardiac malformations after considering women with depression and assessing confounders.

The authors discussed a few limitations to their study, including looking at the prescription of antidepressants but recognizing uncertainty about actual use. The study was limited to women who maintained commercial insurance during pregnancy. In addition, controlling for some confounders (eg, substance use) and looking at symptom severity was not studied and may be helpful to look at in future studies.

When considering limitations, this study provides literature support for providers to counsel pregnant mothers on the risks of antidepressant use during pregnancy.