title: The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists.
abstract: OBJECTIVE
  To address the maternal and neonatal risks of both depression and antidepressant exposure and develop algorithms for periconceptional and antenatal management.
  
  
  METHODS
  Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician collaborated to review English language articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing. Articles were obtained from Medline searches and bibliographies. Search keywords included pregnancy, pregnancy complications, pregnancy outcomes, depressive disorder, depressive disorder/dt, abnormalities/drug-induced/epidemiology, abnormalities/drug-induced/et. Iterative draft manuscripts were reviewed until consensus was achieved.
  
  
  RESULTS
  Both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder. Short-term neonatal irritability and neurobehavioral changes are also linked with maternal depression and antidepressant treatment. Several studies report fetal malformations in association with first trimester antidepressant exposure but there is no specific pattern of defects for individual medications or class of agents. The association between paroxetine and cardiac defects is more often found in studies that included all malformations rather than clinically significant malformations. Late gestational use of selective serotonin reuptake inhibitor antidepressants is associated with transitory neonatal signs and a low risk for persistent pulmonary hypertension in the newborn. Psychotherapy alone is an appropriate treatment for some pregnant women; however, others prefer pharmacotherapy or may require pharmacological treatment.
  
  
  CONCLUSIONS
  Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or problematic health behaviors that can adversely affect pregnancy.
mesh_terms: D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D047109:Fetal Development / Q000187:drug effects; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000628:therapy*; D011256:Pregnancy Outcome
chemical_list: D000928:Antidepressive Agents
references.citation: Am J Psychiatry. 2002 Dec;159(12):2055-61
references.pmid: 12450956
references.citation: JAMA. 1999 Oct 6;282(13):1264-9
references.pmid: 10517430
references.citation: J Obstet Gynaecol. 2004 Jan;24(1):28-32
references.pmid: 14675977
references.citation: Eur J Clin Pharmacol. 2004 Jul;60(5):355-61
references.pmid: 15168103
references.citation: Arch Pediatr Adolesc Med. 2004 Apr;158(4):312-6
references.pmid: 15066868
references.citation: J Clin Psychopharmacol. 2007 Dec;27(6):607-13
references.pmid: 18004128
references.citation: BJOG. 2008 Jul;115(8):1043-51
references.pmid: 18651886
references.citation: J Womens Health (Larchmt). 2003 Jul-Aug;12(6):569-76
references.pmid: 13678512
references.citation: Birth Defects Res A Clin Mol Teratol. 2007 Apr;79(4):301-8
references.pmid: 17216624
references.citation: Hosp Community Psychiatry. 1994 May;45(5):444-50
references.pmid: 8045538
references.citation: Infant Behav Dev. 2006 Apr;29(2):230-42
references.pmid: 17138278
references.citation: Mol Psychiatry. 2008 Jan;13(1):65-73
references.pmid: 17519929
references.citation: Am J Psychiatry. 2002 Nov;159(11):1889-95
references.pmid: 12411224
references.citation: Obstet Gynecol. 2005 Dec;106(6):1289-96
references.pmid: 16319254
references.citation: J Clin Epidemiol. 1992 Oct;45(10):1093-9
references.pmid: 1474405
references.citation: Am J Obstet Gynecol. 2000 Sep;183(3):759-69
references.pmid: 10992206
references.citation: Am J Obstet Gynecol. 2006 Apr;194(4):961-6
references.pmid: 16580283
references.citation: Arch Gen Psychiatry. 2006 Aug;63(8):898-906
references.pmid: 16894066
references.citation: Postgrad Med. 2001 Mar;(Spec No):1-107
references.pmid: 11500997
references.citation: Am J Epidemiol. 1999 Jun 1;149(11):1025-9
references.pmid: 10355378
references.citation: Pharmacoepidemiol Drug Saf. 2007 May;16(5):474-84
references.pmid: 16897811
references.citation: Paediatr Respir Rev. 2005 Jun;6(2):111-6
references.pmid: 15911456
references.citation: Ann Pharmacother. 2005 May;39(5):803-9
references.pmid: 15784808
references.citation: Can J Psychiatry. 2003 Mar;48(2):106-10
references.pmid: 12655908
references.citation: J Clin Psychiatry. 2004 Feb;65(2):230-7
references.pmid: 15003078
references.citation: Am J Psychiatry. 1993 Oct;150(10):1541-2
references.pmid: 8379562
references.citation: Pediatrics. 2004 Feb;113(2):368-75
references.pmid: 14754951
references.citation: JAMA. 1993 May 5;269(17):2246-8
references.pmid: 8474204
references.citation: N Engl J Med. 1997 Jan 23;336(4):258-62
references.pmid: 8995088
references.citation: Arch Womens Ment Health. 2006 Nov;9(6):309-15
references.pmid: 17013761
references.citation: Am J Psychiatry. 2001 Oct;158(10):1728-30
references.pmid: 11579012
references.citation: Am J Epidemiol. 2004 May 1;159(9):872-81
references.pmid: 15105180
references.citation: JAMA. 1998 Feb 25;279(8):609-10
references.pmid: 9486756
references.citation: Infant Behav Dev. 2006 Jul;29(3):445-55
references.pmid: 17138297
references.citation: Am J Psychiatry. 2003 Mar;160(3):555-62
references.pmid: 12611838
references.citation: Am J Psychiatry. 2004 Apr;161(4):608-20
references.pmid: 15056503
references.citation: N Engl J Med. 2006 Feb 9;354(6):579-87
references.pmid: 16467545
references.citation: Am J Psychiatry. 1996 May;153(5):592-606
references.pmid: 8615404
references.citation: Reprod Toxicol. 2006 Apr;21(3):221-2
references.pmid: 16406480
references.citation: Pharmacoepidemiol Drug Saf. 2008 Aug;17(8):801-6
references.pmid: 18314924
references.citation: Child Dev. 2006 May-Jun;77(3):573-87
references.pmid: 16686789
references.citation: N Engl J Med. 1996 Oct 3;335(14):1010-5
references.pmid: 8793924
references.citation: Psychol Med. 1993 Nov;23(4):967-75
references.pmid: 8134520
references.citation: J Clin Psychiatry. 2006 Aug;67(8):1280-4
references.pmid: 16965209
references.citation: Acta Psychiatr Scand. 2004 Jun;109(6):440-6
references.pmid: 15117289
references.citation: JAMA. 2006 Feb 1;295(5):499-507
references.pmid: 16449615
references.citation: Arch Pediatr Adolesc Med. 2002 Nov;156(11):1129-32
references.pmid: 12413342
references.citation: Am J Obstet Gynecol. 2005 Dec;193(6):2004-9
references.pmid: 16325604
references.citation: Evid Rep Technol Assess (Summ). 2005 Feb;(119):1-8
references.pmid: 15760246
references.citation: Hum Reprod. 2002 Oct;17(10):2580-4
references.pmid: 12351532
references.citation: Am J Epidemiol. 2002 Nov 1;156(9):797-802
references.pmid: 12396996
references.citation: Am J Psychiatry. 2007 Aug;164(8):1206-13
references.pmid: 17671283
references.citation: N Engl J Med. 2007 Jun 28;356(26):2684-92
references.pmid: 17596602
references.citation: Br J Psychiatry. 2008 May;192(5):338-43
references.pmid: 18450656
references.citation: Am J Obstet Gynecol. 2007 Jun;196(6):544.e1-5
references.pmid: 17547888
references.citation: N Engl J Med. 2007 Jun 28;356(26):2675-83
references.pmid: 17596601
references.citation: Perspect Sex Reprod Health. 2006 Jun;38(2):90-6
references.pmid: 16772190
references.citation: Arch Gen Psychiatry. 2003 Jul;60(7):720-6
references.pmid: 12860776
references.citation: Am J Psychiatry. 2008 Jun;165(6):749-52
references.pmid: 18381907
references.citation: Birth Defects Res B Dev Reprod Toxicol. 2008 Feb;83(1):68-76
references.pmid: 18293409
references.citation: Am J Obstet Gynecol. 2005 Mar;192(3):932-6
references.pmid: 15746694