title: Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Untreated depression during pregnancy has been associated with increased morbidity and mortality for both mother and child and, as such, optimal treatment strategies are required for this population.
  
  
  BACKGROUND
  There are conflicting data regarding potential risks of prenatal antidepressant treatment.
  
  
  OBJECTIVE
  To determine whether prenatal antidepressant exposure is associated with risk for selected adverse pregnancy or delivery outcomes. DATA SOURCES MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library were searched from their start dates to June 30, 2010. STUDY SELECTION English-language studies reporting outcomes associated with pharmacologic treatment during pregnancy were included. We reviewed 3074 abstracts, retrieved 735 articles, and included 23 studies in this meta-analysis.
  
  
  METHODS
  Study design, antidepressant exposure, adjustment for confounders, and study quality were extracted by 2 independent reviewers.
  
  
  RESULTS
  There was no significant association between antidepressant medication exposure and spontaneous abortion (odds ratio [OR], 1.47; 95% CI, 0.99 to 2.17; P = .055). Gestational age and preterm delivery were statistically significantly associated with antidepressant exposure (mean difference [MD] [weeks], -0.45; 95% CI, -0.64 to -0.25; P < .001; and OR, 1.55; 95% CI, 1.38 to 1.74; P < .001, respectively), regardless of whether the comparison group consisted of all unexposed mothers or only depressed mothers without antidepressant exposure. Antidepressant exposure during pregnancy was significantly associated with lower birth weight (MD [grams], -74; 95% CI, -117 to -31; P = .001); when this comparison group was limited to depressed mothers without antidepressant exposure, there was no longer a significant association. Antidepressant exposure was significantly associated with lower Apgar scores at 1 and 5 minutes, regardless of whether the comparison group was all mothers or only those who were depressed during pregnancy but not exposed to antidepressants.
  
  
  CONCLUSIONS
  Although statistically significant associations between antidepressant exposure and pregnancy and delivery outcomes were identified, group differences were small and scores in the exposed group were typically within the normal ranges, indicating the importance of considering clinical significance. Treatment decisions must weigh the effect of untreated maternal depression against the potential adverse effects of antidepressant exposure.
authors: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, University of Toronto, ON, Canada. l.ross@utoronto.ca
authors: Lori E
authors: LE
authors: Ross
authors: Sophie
authors: S
authors: Grigoriadis
authors: Lana
authors: L
authors: Mamisashvili
authors: Emily H
authors: EH
authors: Vonderporten
authors: Michael
authors: M
authors: Roerecke
authors: Jürgen
authors: J
authors: Rehm
authors: Cindy-Lee
authors: CL
authors: Dennis
authors: Gideon
authors: G
authors: Koren
authors: Meir
authors: M
authors: Steiner
authors: Patricia
authors: P
authors: Mousmanis
authors: Amy
authors: A
authors: Cheung
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced; D000928:Antidepressive Agents / Q000009:adverse effects*; D001034:Apgar Score; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000523:psychology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000139:chemically induced
chemical_list: D000928:Antidepressive Agents