Antidepressant Use in Pregnancy: An Evaluation of Adverse Outcomes Excluding Malformations

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 2,500gm. 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.