open access

Vol 88, No 1 (2017)
Review paper
Published online: 2017-01-31
Get Citation

Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns

Ewa Bałkowiec-Iskra, Dagmara Maria Mirowska-Guzel, Mirosław Wielgoś
DOI: 10.5603/GP.a2017.0007
·
Pubmed: 28157249
·
Ginekol Pol 2017;88(1):36-42.

open access

Vol 88, No 1 (2017)
REVIEW PAPERS Obstetrics
Published online: 2017-01-31

Abstract

Over the last few years, several reports on the safety of antidepressants use in pregnancy have been published. Studies concerning the adverse effects of exposure to selective serotonin reuptake inhibitors (SSRI) during pregnancy on the developing foetus have indicated an increased risk of various congenital malformations and untoward effects such as poor neonatal adaptation syndrome or persistent pulmonary hypertension, but there still remain inconsistencies between various study results. This paper aims at reviewing the literature on the risks of exposure to antidepressants during pregnancy. SSRIs are generally considered as first-line antidepressant treatment in pregnancy, as they are generally safe and effective. To minimize the teratogenic risks, pregnant women should receive the minimal effective dose of the medication. Depression during pregnancy must not be left untreated, and it should also be remembered that the condition may extend into the postpartum period.

Abstract

Over the last few years, several reports on the safety of antidepressants use in pregnancy have been published. Studies concerning the adverse effects of exposure to selective serotonin reuptake inhibitors (SSRI) during pregnancy on the developing foetus have indicated an increased risk of various congenital malformations and untoward effects such as poor neonatal adaptation syndrome or persistent pulmonary hypertension, but there still remain inconsistencies between various study results. This paper aims at reviewing the literature on the risks of exposure to antidepressants during pregnancy. SSRIs are generally considered as first-line antidepressant treatment in pregnancy, as they are generally safe and effective. To minimize the teratogenic risks, pregnant women should receive the minimal effective dose of the medication. Depression during pregnancy must not be left untreated, and it should also be remembered that the condition may extend into the postpartum period.

Get Citation

Keywords

antidepressants, pregnancy, foetus, newborn, adverse effect

About this article
Title

Effect of antidepressants use in pregnancy on foetus development and adverse effects in newborns

Journal

Ginekologia Polska

Issue

Vol 88, No 1 (2017)

Article type

Review paper

Pages

36-42

Published online

2017-01-31

DOI

10.5603/GP.a2017.0007

Pubmed

28157249

Bibliographic record

Ginekol Pol 2017;88(1):36-42.

Keywords

antidepressants
pregnancy
foetus
newborn
adverse effect

Authors

Ewa Bałkowiec-Iskra
Dagmara Maria Mirowska-Guzel
Mirosław Wielgoś

References (42)
  1. Gavin NI, Gaynes BN, Lohr KN, et al. Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol. 2005; 106(5 Pt 1): 1071–1083.
  2. Byatt N, Deligiannidis KM, Freeman MP. Antidepressant use in pregnancy: a critical review focused on risks and controversies. Acta Psychiatr Scand. 2013; 127(2): 94–114.
  3. Gentile S. Untreated depression during pregnancy: short – and long-term effects in offspring. A systemic review. Neuroscience, 2015, S0306-4522(15)00811-8. doi: 10.1016/j.neuroscience.2015.09.001
  4. Beydoun H, Saftlas AF. Physical and mental health outcomes of prenatal maternal stress in human and animal studies: a review of recent evidence. Paediatr Perinat Epidemiol. 2008; 22(5): 438–466.
  5. Buss C, Davis EP, Muftuler LT, et al. High pregnancy anxiety during mid-gestation is associated with decreased gray matter density in 6-9-year-old children. Psychoneuroendocrinology. 2010; 35(1): 141–153.
  6. Farias DR, Pinto Td, Teofilo MM, et al. Prevalence of psychiatric disorders in the first trimester of pregnancy and factors associated with current suicide risk. Psychiatry Res. 2013; 210(3): 962–968.
  7. Yonkers KA, Wisner KL, Steward DE, [et al.]. The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstet Gynecol, 2009, 114: 703-713.
  8. Connolly KR, Thase ME. If at first you don’t succeed. Drugs, 2011, 71: 43-64.
  9. Chisolm MS, Payne JL. Management of psychotropic drugs during pregnancy. BMJ, 2015, 351: h5918
  10. Petersen I, Gilbert RE, Evans SJW, et al. Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from The Health Improvement Network. J Clin Psychiatry. 2011; 72(7): 979–985.
  11. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006; 295(5): 499–507.
  12. Zoega H, Kieler H, Nørgaard M, et al. Use of SSRI and SNRI Antidepressants during Pregnancy: A Population-Based Study from Denmark, Iceland, Norway and Sweden. PLoS ONE. 2015; 10(12): e0144474.
  13. Reefhuis J, Devine O, Friedman JM, et al. National Birth Defects Prevention Study. Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports. BMJ. 2015; 351: h3190.
  14. Furu K, Kieler H, Haglund B, [et al.]. SSRI and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design. BMJ, 2015: 350: h1798.
  15. Bałkowiec- Iskra E, Ryszewska-Pokraśniewicz B, Cessak G. Rola farmakoterapii i psychoterapii w leczeniu zaburzeń depresyjnych [English: The Role of Pharmacotherapy in the Treatment of Depressive Disorders]. Psychiatria po Dyplomie, 2013, 10: 41 – 45.
  16. Sadler TW. SSRIs and heart defects: potential mechanism for the observed associations. Reprod Toxicol, 2011, 32: 484-489.
  17. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152062.htm.
  18. Bérard A, Ramos E, Rey E, et al. First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage. Birth Defects Res. B Dev. Reprod. Toxicol. 2007; 80(1): 18–27.
  19. Alwan S, Friedman JM. Safety of selective serotonin reuptake inhibitors in pregnancy. CNS Drugs. 2009; 23(6): 493–509.
  20. Louik C, Lin AE, Werler MM. First – trimestre use of SSRI and the risk of birth defects. N Engl J Med, 2007, 356: 2675-83.
  21. Bakker MK, Kerstjens-Frederikse WS, Buys CH, et al. First-trimester use of paroxetine and congenital heart defects: a population-based case-control study. Birth Defects Res. Part A Clin. Mol. Teratol. 2010; 88(2): 94–100.
  22. Berard A, Zhao J, Sheehy O. Sertraline use during pregnancy and the risk of major malformations. Am J Obstet Gynecol, 2015, 212: 795 e. 1-12.
  23. Klieger-Grossmann C, Weitzner B, Panchaud A, et al. Pregnancy outcomes following use of escitalopram: a prospective comparative cohort study. J Clin Pharmacol. 2012; 52(5): 766–770.
  24. Majewski S, Donnenfeld AE, Kuhlman K, et al. Second-trimester prenatal diagnosis of total arhinia. J Ultrasound Med. 2007; 26(3): 391–395.
  25. Potts AL, Young KL, Carter BS, et al. Necrotizing enterocolitis associated with in utero and breast milk exposure to the selective serotonin reuptake inhibitor, escitalopram. J Perinatol. 2007; 27(2): 120–122.
  26. Bellantuono C, Bozzi F, Orsolini L, et al. The safety of escitalopram during pregnancy and breastfeeding: a comprehensive review. Hum Psychopharmacol. 2012; 27(6): 534–539.
  27. Ban L, Gibson JE, West J, et al. Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG. 2014; 121(12): 1471–1481.
  28. Wang S, Yang L, Wang L, et al. Selective Serotonin Reuptake Inhibitors (SSRIs) and the Risk of Congenital Heart Defects: A Meta-Analysis of Prospective Cohort Studies. J Am Heart Assoc. 2015; 4(5).
  29. Polen K, Rasmusssen S, Riehle-Colarusso, [et al.]. Association between reported venlafaxine use in early pregnancy and birth defects. National Birth Defects Research, 2013, 97: 28-35.
  30. The Bupropion Pregnancy Registry. Final report. 1 September 2007 through 31 March 2008. Wilmington, NC, 2008.
  31. Alwan S, Reefhuis J, Botto LD, et al. National Birth Defects Prevention Study. Maternal use of bupropion and risk for congenital heart defects. Am. J. Obstet. Gynecol. 2010; 203(1): 52.e1–52.e6.
  32. Louik C, Kerr S, Mitchell AA. First-trimester exposure to bupropion and risk of cardiac malformations. Pharmacoepidemiol Drug Saf. 2014; 23(10): 1066–1075.
  33. Huybrechts KF, Palmsten K, Avorn J, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N. Engl. J. Med. 2014; 370(25): 2397–2407.
  34. Levinson-Castiel R, Merlob P, Linder N, et al. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. 2006; 160(2): 173–176.
  35. Oberlander TF, Misri S, Fitzgerald CE, et al. Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry. 2004; 65(2): 230–237.
  36. Kieviet N, Dolman KM, Honig A. The use of psychotropic medication during pregnancy: how about the newborn? Neuropsychiatr Dis Treat. 2013; 9: 1257–1266.
  37. Boucher N, Koren G, Beaulac-Baillargeon L. Maternal use of venlafaxine near term: correlation between neonatal effects and plasma concentrations. Ther Drug Monit. 2009; 31(3): 404–409.
  38. Stewart DE. Clinical practice. Depression during pregnancy. N. Engl. J. Med. 2011; 365(17): 1605–1611.
  39. Klinger G, Frankenthal D, Merlob P, et al. Long-term outcome following selective serotonin reuptake inhibitor induced neonatal abstinence syndrome. J Perinatol. 2011; 31(9): 615–620.
  40. Walsh-Sukys MC, Tyson JE, Wright LL, et al. Persistent Pulmonary Hypertension of the Newborn in the Era Before Nitric Oxide: Practice Variation and Outcomes. PEDIATRICS. 2000; 105(1): 14–20.
  41. Grigoriadis S, Vonderporten EH, Mamisashvili L, et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ. 2014; 348: f6932.
  42. Bałkowiec-Iskra E. Bezpieczeństwo stosowania wybiórczych inhibitorów wychwytu zwrotnego serotoniny w czasie ciąży [English: The Safety of SSRI Use in Pregnancy]. Psychiatr Pol. 2015; 49: 1113–1115.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl