Antidepressant use in pregnancy: an evaluation of adverse outcomes excluding malformation.
BACKGROUND
To date, many studies have been published regarding the safety of antidepressant use in pregnancy. However, most have been regarding a possible association with major malformations and there have been relatively few studies that have examined other infant outcomes specifically.


OBJECTIVE
To evaluate possible adverse effects of antidepressant use in pregnancy.


METHODS
We searched the literature, using Medline, PUBMED, Embase, and Reprotox , and retrieved key articles and reviews of the topic.We examined all outcomes with the exception of major/minor malformations.


RESULTS
We did not find an overall increased risk associated with lower mean birthweight, small for gestational age or long-term neurodevelopmental adverse outcomes. However, there does appear to be a significantly increased risk for spontaneous abortion, preterm birth and low birthweight less than 2,500 gm. In addition, a possible increased risk for Persistent Pulmonary Hypertension of the Newborn (PPHN) and evidence of Poor Neonatal Adaptation Syndrome (PNAS) following use in late pregnancy. All of the observed risks were of a very low magnitude and the clinical significance of these results is unknown.


CONCLUSIONS
This information should not preclude a pregnant women from being treated for depression if required, as untreated depression is also associated with adverse effects on the infant.However, further research needs to be conducted where it is possible to control for maternal depression, in order to evaluate whether these adverse events are due to the underlying maternal illness, the antidepressant, or possibly a combination of both.
Psinapsys Psychiatric Private Center, Buenos Aires, Argentina.
Laura
L
Lorenzo
The Motherisk Program, The Hospital for Sick Children, Toronto, Canada.
Adrienne
A
Einarson
D000022:Abortion, Spontaneous / Q000139:chemically induced*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced*
D000928:Antidepressive Agents