Untreated perinatal depression and anxiety increase the risk of pregnancy complications, introducing significant maternal and neonatal complications. Unfortunately, antidepressant treatment with selective serotonin reuptake inhibitors (SSRIs) is similarly associated with adverse perinatal outcomes. Providers should consider all maternal and fetal outcomes when addressing this dilemma.
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References
1.
YonkersKA, WisnerKL, StewartDE, et al. The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol2009;114(3):703–713.
2.
American College of Obstetricians and Gynecologists. Committee on Obstetric Practice. Committee opinion no. Screening for depression during and after pregnancy.. Obstet Gynecol2010;115(2 Pt 1):394–395.
3.
DossettEC. Perinatal depression. Obstet Gynecol Clin North Am2008;35(3):419–434.
4.
CohenLS, AltshulerLL, HarlowBL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA2006;295(5):499–507.
5.
El MarrounH, JaddoeVW, HudziakJJ, et al. Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Arch Gen Psychiatry2012;69(7):706–714.
6.
AlwanS, ReefhuisJ, RasmussenSA, OlneyRS, FriedmanJM, National Birth Defects Prevention Study. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med2007;356(26):2684–2692.
7.
WogeliusP, NorgaardM, GislumM, et al. Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations. Epidemiology2006;17(6):701–704.
8.
HuybrechtsKF, PalmstenK, AvornJ, CohenLS, HolmesLB, FranklinJM, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med2014;370(25):2397–2407.
9.
LouikC, LinAE, WerlerMM, Hernandez-DiazS, MitchellAA. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med356(26):2675–2683.
10.
PedersenLH, HenriksenTB, VestergaardM, OlsenJ, BechBH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: Population based cohort study. BMJ2009;339:b3569.
11.
MylesN, NewallH, WardH, LargeM. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust N Z J Psychiatry2013;47(11):1002–1012.
12.
AndersenJT, AndersenNL, HorwitzH, PoulsenHE, Jimenez-SolemE. Exposure to selective serotonin reuptake inhibitors in early pregnancy and the risk of miscarriage. Obstet Gynecol2014;124(4):655–661.
13.
WisnerKL, SitDK, HanusaBH, et al. Major depression and antidepressant treatment: Impact on pregnancy and neonatal outcomes. Am J Psychiatry2009;166(5):557–566.
14.
HayesRM, WuP, SheltonRC, et al. Maternal antidepressant use and adverse outcomes: A cohort study of 228,876 pregnancies. Am J Obstet Gyneco2012;207(1):49.e1–e9.
15.
ChambersCD, JohnsonKA, DickLM, FelixRJ, JonesKL. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med1996;335(14):1010–1015.
16.
HuybrechtsKF, BatemanBT, PalmstenK, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA2015;313(21):2142–2151.
17.
KielerH, ArtamaM, EngelandA, et al. Selective serotonin reuptake inhibitors during pregnancy and risk of persistent pulmonary hypertension in the newborn: Population based cohort study from the five Nordic countries. BMJ2012;344:d8012.
18.
WilsonKL, ZeligCM, HarveyJP, CunninghamBS, DolinskyBM, NapolitanoPG. Persistent pulmonary hypertension of the newborn is associated with mode of delivery and not with maternal use of selective serotonin reuptake inhibitors. Am J Perinatol2011;28(1):19–24.
19.
AndradeSE, McPhillipsH, LorenD, et al. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf2009;18(3):246–252.
20.
GrigoriadisS, VonderportenEH, MamisashviliL, et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: Systematic review and meta-analysis. BMJ2014;348:f6932.
21.
WinovitchKC, PadillaL, GhamsaryM, LagrewDC, WingDA. Persistent pulmonary hypertension of the newborn following elective cesarean delivery at term. J Matern Fetal Neonatal Med2011;24(11):1398–1402.
22.
PedersenLH, HenriksenTB, BechBH, LichtRW, KjaerD, OlsenJ. Prenatal antidepressant exposure and behavioral problems in early childhood–a cohort study. Acta Psychiatr Scand2013;127(2):126–135.
23.
HviidA, MelbyeM, PasternakB. Use of selective serotonin reuptake inhibitors during pregnancy and risk of autism. N Engl J Med2013;369(25):2406–2415.
24.
CroenLA, GretherJK, YoshidaCK, OdouliR, HendrickV. Antidepressant use during pregnancy and childhood autism spectrum disorders. Arch Gen Psychiatry2011;68(11):1104–1112.
25.
HarringtonRA, LeeLC, CrumRM, ZimmermanAW, Hertz-PicciottoI. Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatricse2014;133(5):1241–1248.
26.
GentileS. Prenatal antidepressant exposure and the risk of autism spectrum disorders in children. Are we looking at the fall of Gods?. J Affect Disord2015;182:132–137.
27.
El MarrounH, WhiteTJ, van der KnaapNJ, et al. Prenatal exposure to selective serotonin reuptake inhibitors and social responsiveness symptoms of autism: Population-based study of young children. Br J Psychiatry2014;205(2):95–102.
28.
DeligiannidisKM, FreemanMP. Complementary and alternative medicine therapies for perinatal depression. Best Pract Res Clin Obstet Gynaecol2014;28(1):85–95.
29.
KjaersgaardMI, ParnerET, VestergaardM, SorensenMJ, OlsenJ, ChristensenJ, et al. Prenatal antidepressant exposure and risk of spontaneous abortion - a population-based study. PLoS One2013;8(8):e72095.
