Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes

Abstract

Objective: Selective serotonin reuptake inhibitor (SSRI) use during pregnancy incurs a low absolute risk for major malformations; however, other adverse outcomes have been reported. Major depression also affects reproductive outcomes. This study examined whether 1) minor physical anomalies, 2) maternal weight gain and infant birth weight, 3) preterm birth, and 4) neonatal adaptation are affected by SSRI or depression exposure.

Method: This prospective observational investigation included maternal assessments at 20, 30, and 36 weeks of gestation. Neonatal outcomes were obtained by blinded review of delivery records and infant examinations. Pregnant women (N=238) were categorized into three mutually exclusive exposure groups: 1) no SSRI, no depression (N=131); 2) SSRI exposure (N=71), either continuous (N=48) or partial (N=23); and 3) major depressive disorder (N=36), either continuous (N=14) or partial (N=22). The mean depressive symptom level of the group with continuous depression and no SSRI exposure was significantly greater than for all other groups, demonstrating the expected treatment effect of SSRIs. Main outcomes were minor physical anomalies, maternal weight gain, infant birth weight, pregnancy duration, and neonatal characteristics.

Results: Infants exposed to either SSRIs or depression continuously across gestation were more likely to be born preterm than infants with partial or no exposure. Neither SSRI nor depression exposure increased risk for minor physical anomalies or reduced maternal weight gain. Mean infant birth weights were equivalent. Other neonatal outcomes were similar, except 5-minute Apgar scores.

Conclusions: For depressed pregnant women, both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20%.

Trial registration: ClinicalTrials.gov NCT00279370.

FIGURE 1

Enrollment of Pregnant Women in Study of SSRI Antidepressants and Depression ^a The groups with continuous exposure also include women exposed for the majority of each of the three trimesters. ^b The groups with partial exposure had at least one trimester free of exposure.

FIGURE 2

Baseline Depression and Global Functioning of Women With or Without Exposure to SSRI Antidepressants and Depression During Pregnancya ^a Within each box, the white line represents the median value. The top and bottom edges of the box represent the 75th and 25th percentiles, respectively; these define the interquartile range. Each bar attached to the box represents 1.5 times the interquartile range; the filled circles are outliers. ^b 29-item Structured Interview Guide for the Hamilton Depression Rating Scale With Atypical Depression Supplement (29).

FIGURE 3

Relation of Infant’s Gestational Age at Birth to Mother’s Exposure to SSRI Antidepressants and Depression During Pregnancy