Impact of Antidepressants in Pregnancy on Unborn Child
On the surface, the results of these two studies are somewhat confusing: Among the possible explanations for the different findings are methodologic limitations of the Stanford study. The Motherisk study was a controlled study in which maternal mood during pregnancy and the postpartum period was assessed prospectively. But the mood of women in the Stanford study was not prospectively assessed; a significant number had already given birth when they were asked to recall what their mood was during pregnancy. As a result, the impact of antidepressant therapy on their mood is unknown. This is a major confounding factor because of the considerable data indicating that maternal mood disorders can adversely affect neurobehavioral function in children.
The results of the Stanford study are interesting, but given these methodologic limitations, it is particularly difficult to draw any conclusions from it or to use the findings to inform clinical care. There certainly is nothing in these findings to suggest that women should avoid taking antidepressants during pregnancy.
The Stanford authors, who acknowledged the difficulty in controlling for certain confounding variables and concluded that it should be viewed as a pilot study, should still be commended for their efforts to perform prospective neurobehavioral assessments and address the potential for behavioral teratogenicity--information that is profoundly lacking in the literature.
Multiple studies have shown the importance of keeping women euthymic during pregnancy, in light of the adverse effects of maternal depression on perinatal outcome and the extent to which maternal depression in pregnancy predicts postpartum depression.
In future studies, it will be important to include prospective assessments of both maternal mood and drug exposure, so the two variables can be teased apart in terms of their relative contribution to both perinatal outcome and long-term neurobehavioral outcome.
Dr. Lee Cohen is a psychiatrist and director of the perinatal psychiatry program at Massachusetts General Hospital, Boston. He is a consultant for and has received research support from manufacturers of several SSRIs. He is also a consultant to Astra Zeneca, Lilly and Jannsen - manufacturers of atypical antipsychotics. He originally wrote this article for ObGyn News.
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Last Updated: 07 December 2015
Reviewed by Harry Croft, MD