The effect of perinatal exposures on the infant: Antidepressants and depression

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2014-01, Vol.28 (1), p.37-48
• Main Authors: Hanley, Gillian E., PhD, Oberlander, Tim F., MD, FRCPc
• Format: Article
• Language: English
• Subjects: Antidepressive Agents - adverse effects; Anxiety - psychology; Child Behavior Disorders - etiology; Depression - drug therapy; Depression - psychology; Female; General Adaptation Syndrome - chemically induced; Heart Defects, Congenital - chemically induced; Humans; infant outcomes; Infant, Newborn; Obstetrics and Gynecology; Persistent Fetal Circulation Syndrome - chemically induced; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy Complications - psychology; Prenatal Exposure Delayed Effects - chemically induced; Prenatal Exposure Delayed Effects - psychology; prenatal maternal depression; serotonin reuptake inhibitors; Serotonin Uptake Inhibitors - adverse effects
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2013.09.001

Depression, anxiety, or both, during pregnancy are common complications during the perinatal period, with 15–20% of women experiencing depression at some point during their pregnancy. Considerable evidence suggests that untreated or undertreated maternal Axis I mood disorders can increase the risk for preterm birth, low birth weight, and alter neurobehavioral development in utero . Serotonin reuptake inhibitor antidepressants are often considered for antenatal therapy, with the goal of improving maternal mental health during pregnancy. Treatment with a serotonin-reuptake inhibitor, however, does not guarantee remission of depression, and in-utero serotonin reuptake inhibitor exposure has also been linked to increased risks for adverse infant outcomes. In this chapter, evidence linking serotonin reuptake inhibitor use with an increased risk for postnatal adaptation syndrome, congenital heart defects, and neonatal persistent pulmonary hypertension is reviewed. Management decisions should include attention to the continuum of depression symptoms, from subclinical to severe major depressive disorder and the long-term developmental risks that might also be associated with pre- and postnatal exposure.