Antidepressants and Pregnancy: Continued Evidence of Harm-Still No Evidence of Benefit

Article excerpt

Antidepressant medication use during pregnancy is increasing. It is essential that women of childbearing age, pregnant women, and their health care providers be aware of the risks, benefits, and alternatives prior to taking these agents. The best available evidence suggests that antidepressant use by pregnant women may be associated with miscarriage, birth defects, preterm birth, decreased birth weight, neonatal behavioral syndrome, persistent pulmonary hypertension in the newborn, neonatal electrocardiogram (EKG) changes, and behavioral effects. Evidence of benefit is lacking. The hope that improved maternal mood through medication would lead to better pregnancy results has not been realized; the antidepressant-exposed pregnancies are faring worse. The available evidence raises the question: Are we exposing a generation of women and their babies to drugs that are causing significantly more harm than good?

Keywords: depression; pregnancy; antidepressants; serotonin reuptake inhibitors

Whether to take an antidepressant during pregnancy is an important decision that must balance maternal mental health considerations with fetal/pregnancy exposure issues. Each pregnant woman and her health care providers must weigh the risks, benefits, and alternatives to medication use in pregnancy. Much attention has focused on the risks of antidepressant use during pregnancy. A significant misconception, however, surrounds the issue of benefit and how maternal medication use may affect obstetrical outcomes.

Numerous studies have now shown antidepressant use during pregnancy to be associated with increased rates of miscarriage (Nakhai-Pour, Broy, & Bérard, 2010), birth defects (Pedersen, Henriksen, Vestergaard, Olsen, & Bech, 2009), preterm birth (Suri et al., 2007), decreased birth weight (Oberlander, Warburton, Misri, Aghajanian, & Hertzman, 2006), neonatal behavioral syndrome (Sanz, De-las-Cuevas, Kiuru, Bate, & Edwards, 2005), persistent pulmonary hypertension in the newborn (Chambers, et al., 2006), neonatal electrocardiogram (EKG) changes (Dubnov-Raz et al., 2008), and behavioral effects (Ruchkin & Martin, 2005). No study has shown any improvement in obstetrical outcomes in women taking antidepressants.

Fluoxetine (Prozac) was launched in the late 1980s and the use of antidepressant medications has risen steadily ever since. Women of childbearing age make up a significant percentage of users, making exposure during pregnancy commonplace. Rates of use during pregnancy have increased over time and are now estimated to be as high as 13.4% ( Cooper, Willy, Pont, & Ray, 2007) and rising (Bakker, Kölling, van den Berg, de Walle, & de Jong van den Berg, 2008).

The hope for all who care for pregnant women has been that antidepressant use would lead to improved maternal mood, which would translate into better maternal self-care and the avoidance of habits such as alcohol and tobacco. The improved mood and better habits would, in turn, lead to better obstetrical outcomes: for example, less preterm birth, higher birth weights, and healthier newborns.

This has been the hope for antidepressant use during pregnancy. Unfortunately, the reality tells a different story. Starting in the 1990s, questions were raised about the effects of these drugs on pregnancies. Time and again the studies have shown worsened pregnancy outcomes in those women on antidepressants. At best, some studies show no difference. It is notable that not a single study has ever shown improvement in pregnancy outcomes in those women who are taking medication. The hoped for improvements that theoretically could arise with better maternal mood have not come to fruition.

he most common explanation given for the consistent research finding of increased obstetrical complication rates among antidepressant users is that the depressed pregnant women taking medications are different from the women not on these drugs (i. …