Perinatal risks of untreated depression during pregnancy.
OBJECTIVE
To review the literature on the perinatal risks involved in untreated depression during pregnancy.


METHODS
We searched Medline and medical texts for all studies pertaining to this area up to the end of April 2003. Key phrases entered were depression and pregnancy, depression and pregnancy outcome, and depression and untreated pregnancy. We did not include bipolar depression.


RESULTS
While there is wide variability in reported effects, untreated depression during pregnancy appears to carry substantial perinatal risks. These may be direct risks to the fetus and infant or risks secondary to unhealthy maternal behaviours arising from the depression. Recent human data suggest that untreated postpartum depression, not treatment with antidepressants in pregnancy, results in adverse perinatal outcome.


CONCLUSIONS
The biological dysregulation caused by gestational depression has not received appropriate attention: most studies focus on the potential but unproven risks of psychotropic medication. No in-depth discussion of the role of psychotherapy is available. Because they are not aware of the potentially catastrophic outcome of untreated maternal depression, this imbalance may lead women suffering from depression to fear teratogenic effects and refuse treatment.
Bonari
Lori
L
The Hospital for Sick Children and the Department of of Pharmacology, University of Toronto, Toronto, Ontario.
Pinto
Natasha
N
Ahn
Eric
E
Einarson
Adrienne
A
Steiner
Meir
M
Koren
Gideon
G
D000022:Abortion, Spontaneous; D001921:Brain / Q000378:metabolism / Q000503:physiopathology*; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D003863:Depression / Q000378:metabolism / Q000503:physiopathology* / Q000523:psychology*; D005260:Female; D005316:Fetal Distress; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism / Q000503:physiopathology; D007231:Infant, Newborn; D007234:Infant, Premature; D010500:Perinatology; D010913:Pituitary-Adrenal System / Q000378:metabolism / Q000503:physiopathology; D011225:Pre-Eclampsia; D011247:Pregnancy / Q000523:psychology*; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D012307:Risk Factors
D003346:Corticotropin-Releasing Hormone