title: Antidepressant use in pregnancy: a critical review focused on risks and controversies.
abstract: OBJECTIVE
  Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations.
  
  
  METHODS
  MEDLINE/PubMed was searched for reports and studies on the risk of first-trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure.
  
  
  RESULTS
  While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association.
  
  
  CONCLUSIONS
  Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women's preference should guide treatment decisions.
authors.affiliation: Psychiatry and Obstetrics & Gynecology, Psychosomatic Medicine, Women's Mental Health, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, MA 01655, USA. nancy.byatt@umassmemorial.org
authors.forename: N
authors.initials: N
authors.lastname: Byatt
authors.forename: K M
authors.initials: KM
authors.lastname: Deligiannidis
authors.forename: M P
authors.initials: MP
authors.lastname: Freeman
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D017374:Paroxetine / Q000009:adverse effects / Q000627:therapeutic use; D010547:Persistent Fetal Circulation Syndrome / Q000139:chemically induced; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000523:psychology; D011261:Pregnancy Trimester, First / Q000187:drug effects; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors