Advertisement

Archives of Women's Mental Health

, Volume 21, Issue 5, pp 505–516 | Cite as

Comparative effects of antidepressant medications and untreated major depression on pregnancy outcomes: a systematic review

  • Jentina Mitchell
  • Janice Goodman
Review Article

Abstract

Psychopharmacological treatment of pregnant women is an area of continued controversy; extensive observational research on the use of antidepressant medications in pregnancy has found these medications to be associated with increased risk of spontaneous abortion, preterm delivery, and low birth weight. However, depression itself has also been associated with increased risk of those same outcomes, and only recently have researchers begun trying to compare treated with untreated depression. The purpose of this study was to conduct a systematic review of the literature to integrate those comparative studies and compare risks and benefits. PubMed, PsycInfo, and CINAHL searches; study selection; and data extraction were carried out using PRISMA guidelines. Eleven prospective observational and case-control studies were selected for final inclusion. Risk of low birth weight and related outcomes do not differ between antidepressant-treated pregnant women and untreated depressed women. Average gestational lengths tend to be slightly shorter with antidepressant use but it is unclear whether these differences are clinically meaningful or extend to preterm delivery. Very limited research on spontaneous abortion did not allow conclusions to be drawn regarding that outcome. The low number of studies meeting criteria highlights the need for further research to aid in risk-benefit analysis for women considering antidepressant use in pregnancy. While further research is necessary, discontinuing antidepressant treatment of major depression in pregnancy due to concerns about length of gestation, birth weight, or spontaneous abortion is not supported by the evidence available at this time.

Keywords

Peripartum depression Antidepressants Pregnancy Preterm birth Birth weight 

Notes

Acknowledgements

The authors thank Jessica Bell MS (MGH Institute of Health Professions) for assistance with database search strategy and Brendon Stubbs PhD (Kings College London) for advice on feasibility of meta-analysis.

Funding source

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. Battle CL, Salisbury AL, Schofield CA, Ortiz-Hernandez S (2013) Perinatal antidepressant use: understanding women’s preferences and concerns. J Psychiatr Pract 19(6):443–453CrossRefPubMedPubMedCentralGoogle Scholar
  2. Byatt N, Biebel K, Debordes-Jackson G, Lundquist RS, Moore Simas TA, Weinreb L, Ziedonis Z (2013) Community mental health provider reluctance to provide pharmacotherapy may be a barrier to addressing perinatal depression: a preliminary study. Psychiatry Q 84:169–174CrossRefGoogle Scholar
  3. Dimidjian S, Goodman S (2009) Nonpharmacologic intervention and prevention strategies for depression during pregnancy and the postpartum. Clin Obstet Gynecol 52:3CrossRefGoogle Scholar
  4. El Marroun H, Jaddoe VWV, Hudziak JJ, Roza SJ, Steegers EAP, Hofman A, Verhulst FC, White TJH, Stricker BHC, Tiemeier H (2012) Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes. Arch Gen Psychiatry 69(7):706–714 Included in reviewCrossRefPubMedGoogle Scholar
  5. Goodman JH (2009) Women’s attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 36:1CrossRefGoogle Scholar
  6. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ (2010) A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry 67(10):1012–1024CrossRefPubMedPubMedCentralGoogle Scholar
  7. Hannerfors AK, Hellgren C, Schijven D, Iliadis SI, Comasco E, Skalkidou A, Oliver JDA, Sundstrom-Pomoraa I (2015) Treatment with serotonin reuptake inhibitors during pregnancy is associated with elevated corticotropin-releasing hormone levels. Psychoneuroendocrinology 58:104–113 Included in reviewCrossRefPubMedGoogle Scholar
  8. Hayes RM, Wu P, Shelton RC, Cooper WO, Dupont WD, Mitchel E, Hartert TV (2012) Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies. Am J Obstet Gynecol 207:49CrossRefPubMedPubMedCentralGoogle Scholar
  9. Hemels ME, Einarson A, Koren G, Lanctot KL, Einarson TR (2005) Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother 39:803–809CrossRefPubMedGoogle Scholar
  10. Huang H, Coleman S, Bridge JA, Yonkers K, Katon W (2014) A meta-analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and low birth weight. Gen Hosp Psychiatry 36(2014):13–18CrossRefPubMedGoogle Scholar
  11. Huybrechts KF, Sanghani RS, Avorn J, Urato AC (2014) Preterm birth and antidepressant medication use during pregnancy: a systematic review and meta-analysis. PLoS One 9:3CrossRefGoogle Scholar
  12. Jensen HM, Gron R, Lidegaard O, Pedersen LH, Andersen PK, Kessing LV (2013) The effects of maternal depression and use of antidepressants during pregnancy on risk of a child small for gestational age. Psychopharmacology 228:199–205 Included in reviewCrossRefPubMedGoogle Scholar
  13. Kjaersgaard MIS, Parner ET, Vestergaard M, Sorensen MJ, Olsen J, Christensen J, Bech BH, Pedersen LH (2013) Prenatal antidepressant exposure and risk of spontaneous abortion—a population-based study. PLoS One 8(8):e72095 Included in reviewCrossRefPubMedPubMedCentralGoogle Scholar
  14. Lewis AJ, Galbally M, Bailey CM (2012) Perinatal mental health, antidepressants and neonatal outcomes: findings from the longitudinal study of Australian children. Neonatal Paediatr Child Health Nurs 15:3Google Scholar
  15. Li D, Liu L, Odouli R (2009) Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 24(1):2044–2045CrossRefGoogle Scholar
  16. “Low birthweight” (2014) March of dimes health topics. [http://www.marchofdimes.org/complications/low-birthweight.aspx]
  17. Lund N, Pedersen L, Henriksen TB (2009) Selective Serotonin Reuptake Inhibitor Exposure In Utero and Pregnancy Outcomes. Arch Pediatr Adolesc Med 163(10):949–954Google Scholar
  18. Miniati M, Callari A, Calugi S, Rucci P, Savino M, Mauri M, Dell'Osso L (2014) Interpersonal psychotherapy for postpartum depression: a systematic review. Arch Women’s Ment Health 17(4):257–268CrossRefGoogle Scholar
  19. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  20. Oberlander TF, Warburton W, Misri S, Aghajanian J, Hertzman C (2006) Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 63(8):898–906 Included in reviewCrossRefPubMedGoogle Scholar
  21. O'Mahen HA, Flynn HA (2008) Preferences and perceived barriers to treatment for depression during the perinatal period. J Women's Health 17(8):1301–1309CrossRefGoogle Scholar
  22. Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  23. Reefhuis J, Devine O, Friedman JM, Louik C, Honein MA (2015) Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. Br Med J 350:h3190CrossRefGoogle Scholar
  24. Robinson GE (2015) Controversies about the use of antidepressants in pregnancy. J Nerv Ment Dis 203(3):159–163CrossRefPubMedGoogle Scholar
  25. Robinson JN and Norwitz ER (2016) “Preterm birth: risk factors and interventions for risk reduction.” UpToDate Google Scholar
  26. Ross LE, Grigoriadis S, Mamisashvili L, VonderPorten EH, Roerecke M, Rehm J, Dennis C, Koren G, Steiner M, Mousmanis P, Cheung A (2013) Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis. JAMA Psychiatry 70(4):436–443CrossRefPubMedGoogle Scholar
  27. Sahingoz M, Yuksel G, Karsidag C, Uguz F, Sonmez EO, Annagur BB, Annagur A (2014) Birth weight and preterm birth in babies of pregnant women with major depression in relation to treatment with antidepressants. J Clin Psychopharmacol 34(2):226–229 Included in reviewCrossRefPubMedGoogle Scholar
  28. Salisbury AL, Wisner KL, Pearlstein T, Battle CL, Stroud L, Lester BM (2011) Newborn neurobehavioral patterns are differentially related to prenatal maternal major depressive disorder and serotonin reuptake inhibitor treatment. Depress Anxiety 28:1008–1019 Included in reviewCrossRefPubMedPubMedCentralGoogle Scholar
  29. Sockol LE (2015) A systematic review of the efficacy of cognitive behavioral therapy for treating and preventing perinatal depression. J Affect Disord 177:7–21CrossRefPubMedGoogle Scholar
  30. Stuart S, Koleva H (2014) Psychological treatments for perinatal depression. Best Pract Res Clin Obstet Gynecol 28(1):61–70CrossRefGoogle Scholar
  31. Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J (2007) Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatr 164(8):1206–1213 Included in reviewCrossRefPubMedGoogle Scholar
  32. van Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJ, Kamperman AM (2017) Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment meta-analysis. PLoS One 12(3):e0173397CrossRefPubMedPubMedCentralGoogle Scholar
  33. Viktorin A, Lichtenstein P, Lundholm C, Almqvist C, D’Onofrio BM, Larsson H, Landen M, Magnusson PKE (2016) Selective serotonin re-uptake inhibitor use during pregnancy: association with offspring birth size and gestational age. Int J Epidemiol 45(1):170177 Included in reviewCrossRefPubMedGoogle Scholar
  34. Weinreb L, Byatt N, Moore Simas TA, Tenner K, Savageau JA (2014) What happens to mental health treatment during pregnancy? Women’s experience with prescribing providers. Psychiatry Q 85:349–355CrossRefGoogle Scholar
  35. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P (2014) The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute. [http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp]
  36. “What are the risk factors for preterm labor and birth?” National Institutes of Health (n.d.). [https://www.nichd.nih.gov/health/topics/preterm/conditioninfo/Pages/who_risk.aspx#f3]
  37. Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, Perel JM, Jones-Ivy S, Bodnar LM, Singer LT (2009) Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatr 166(5):557–566 Included in reviewCrossRefPubMedGoogle Scholar
  38. Yonkers KA, Norwitz ER, Smith MV, Lockwood CJ, Gotman N, Luchansky E, Lin H, Belanger K (2012) Depression and serotonin reuptake inhibitor treatment as risk factors for preterm birth. Epidemiology 23:677–685 Included in reviewCrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.MGH Institute of Health Professions, School of NursingBostonUSA

Personalised recommendations