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Antidepressant Use During Pregnancy Poses Minimal Risk

Toronto, April 26, 2013 - Antidepressants in general do not seem to be associated with birth defects, according to a new meta-analysis published in the April 2013 issue of The Journal of Clinical Psychiatry. Three meta-analyses were led by Sophie Grigoriadis, MD, PhD, FRCPC, from Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada, in the context of a larger program of research. The first synthesized data on congenital malformations, the second on poor neonatal adaptation, and the third on the impact of depression itself.

Depressed pregnant woman“Conflicting reports about antidepressant use during pregnancy have made the process of making treatment decisions extremely complex for clinicians. Our hope is that by providing a stronger evidence base, our work will help to make this process easier,” said Dr. Grigoriadis, also an associate professor at the University of Toronto. 

The authors used the Systematic Appraisal of Quality in Observational Research, a quality assessment tool that they developed, to select more than 60 studies to include in the meta-analyses. Outcomes included birth defects (including cardiac), poor neonatal adaptation, and the impact of maternal depression on premature delivery, gestational age, birth weight, low birth weight, neonatal intensive care unit admission, Apgar scores, preeclampsia, and breastfeeding initiation.

Results did reveal some negative effects of antidepressant exposure, including an increase in risk for poor neonatal adaptation syndrome (PNAS) and the individual signs of  respiratory distress and tremors in infants. The authors identified a significant association between cardiovascular birth defects and exposure to any antidepressant during pregnancy, but they question its clinical significance. They also found that depression during pregnancy is modestly associated with increased risk for premature delivery and lower rates of breastfeeding initiation.  

Dr. Grigoriadis concluded that, “although more methodologically rigorous research is needed,” treatment decisions regarding antidepressant medication requires weighing not only the risks of the medication on the fetus as “the effects of depression were not without consequence and should be given consideration.” In particular, “women who choose to use antidepressant treatment while pregnant should be counseled that the infant may develop PNAS and ensured that if complications arise, they will be identified and treated immediately.”

“Deciding on the appropriate approach to medication use during pregnancy can be a challenge for both mothers and doctors,” said another lead author of the meta-analyses, Lori E. Ross, PhD, from the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. “We hope physicians will use this research to provide expectant mothers with the best available evidence to inform this decision, and work with them to develop a treatment plan that works for them and their families.”

The 3 meta-analyses are available at http://www.psychiatrist.com/pastppp/tocs.asp?toc=online. The authors are Sophie Grigoriadis, MD, PhD, FRCPC; Emily H. VonderPorten, MPH; Lana Mamisashvili, MSW; Michael Roerecke, PhD; Jürgen Rehm, PhD; George Tomlinson PhD; Cindy-Lee Dennis, PhD; Gideon Koren, MD, FRCPC, FACMT; Meir Steiner, MD, PhD, FRCPC; Patricia Mousmanis, MD, CCFP, FCFP; Amy Cheung, MD, MSc, FRCPC; Allison Eady, BA; Kim Radford, BA; Jovana Martinovic, MD; and Lori E. Ross, PhD.

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