title: Depression drug treatment outcomes in pregnancy and the postpartum period: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To evaluate the comparative benefits and harms in both mother and child of antidepressant treatment for depression in pregnant or postpartum women.
  
  
  METHODS
  MEDLINE, the Cochrane Library, CINAHL, Scopus, ClinicalTrials.gov (inception to July 2013), manufacturers, and reference lists.
  
  
  METHODS
  Two reviewers independently selected studies of pregnant women with depression comparing antidepressants with each other, placebo or no treatment, or nondrug treatments. Studies making comparisons among women taking antidepressants for any reason and those not taking antidepressants (depression status unknown) were used to fill gaps in the evidence.
  
  
  RESULTS
  Dual study data extraction and quality assessment were used. Six randomized controlled trials and 15 observational studies provided evidence. Low-strength evidence suggested neonates of pregnant women with depression taking selective serotonin reuptake inhibitors had higher risk of respiratory distress than did neonates of untreated women (13.9% compared with 7.8%; P<.001) but no difference in risk of neonatal convulsions (0.14% compared with 0.11%; P=.64) or preterm birth (17% compared with 10%; P=.07). Indirect evidence from studies of pregnant women receiving antidepressants for mixed or unreported reasons compared with pregnant women not taking antidepressants (depression status unknown) suggested future research should focus on congenital anomalies and autism spectrum and attention deficit disorders in the child. In postpartum depression, low-strength evidence suggested symptom response was not improved when sertraline was added to psychotherapy or when cognitive-behavioral therapy was added to paroxetine. Evidence was insufficient for other outcomes, including depression symptoms, functional capacity, breastfeeding, and infant and child development. A serious limitation is the lack of study populations of exclusively depressed pregnant and postpartum women.
  
  
  CONCLUSIONS
  Evidence about the comparative benefits and harms of pharmacologic treatment of depression in pregnant and postpartum women was largely inadequate to allow informed decisions about treatment. Considering the prevalence of depression, filling this gap is essential.
authors.affiliation: Departments of Medical Informatics and Clinical Epidemiology, Psychiatry, Pediatrics, and Obstetrics and Gynecology, Oregon Health and Science University, School of Medicine, and Portland Veterans Affairs Hospital, Portland, Oregon.
authors.forename: Marian S
authors.initials: MS
authors.lastname: McDonagh
authors.forename: Annette
authors.initials: A
authors.lastname: Matthews
authors.forename: Carrie
authors.initials: C
authors.lastname: Phillipi
authors.forename: Jillian
authors.initials: J
authors.lastname: Romm
authors.forename: Kim
authors.initials: K
authors.lastname: Peterson
authors.forename: Sujata
authors.initials: S
authors.lastname: Thakurta
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
mesh_terms: D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000145:classification; D001942:Breast Feeding / Q000009:adverse effects; D057186:Comparative Effectiveness Research; D019052:Depression, Postpartum / Q000188:drug therapy*; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D064887:Observational Studies as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents