Cited by 158Pregnancy and Medication ImpactMaternal Mental Health During Pregnancy and PostpartumPrenatal Substance Exposure Effects

Antidepressant use in pregnancy: a critical review focused on risks and controversies

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Byatt, N., Deligiannidis, K. M., Freeman, M. P.·2013·Acta Psychiatrica Scandinavica

Abstract

Objective: Conflicting data have led to controversy regarding antidepressant use during pregnancy. The objectives of this study are to i) review the risks of untreated depression and anxiety, ii) review the literature on risks of exposure to antidepressants during pregnancy, iii) discuss the strengths and weaknesses of the different study designs used to evaluate those risks, and iv) provide clinical recommendations. Method: MEDLINE/PubMed was searched for reports and studies on the risk of first‐trimester teratogenicity, postnatal adaptation syndrome (PNAS), and persistent pulmonary hypertension (PPHN) with in utero antidepressant exposure. Results: While some individual studies suggest associations between some specific major malformations, the findings are inconsistent. Therefore, the absolute risks appear small. PNAS occurs in up to 30% of neonates exposed to antidepressants. In some studies, PPHN has been weakly associated with in utero antidepressant exposure, while in other studies, there has been no association. Conclusion: Exposures of concern include that of untreated maternal illness as well as medication exposure. It is vital to have a careful discussion, tailored to each patient, which incorporates the evidence to date and considers methodological and statistical limitations. Past medication trials, previous success with symptom remission, and women's preference should guide treatment decisions.

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  1. [129]GROUP NINOS Inhaled nitric oxide in term and near-term infants: neurodevelopmental follow-up of the neonatal inhaled nitric oxide study group (NINOS) J Pediatr 2000 136 611 7 10802492
  2. [160]WILSON KL ZELIG CM HARVEY JP CUNNINGHAM BS DOLINSKY BM NAPOLITANO PG Persistent pulmonary hypertension of the newborn is associated with mode of delivery and not with maternal use of selective serotonin reuptake inhibitors Am J Perinatol 2011 28 19 24 20607643

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Authors
Byatt, N., Deligiannidis, K. M., & Freeman, M. P.
Affiliations
  • University of Massachusetts Chan Medical School (US)
  • Harvard University (US)
Corresponding author
Byatt, N.
Venue
Acta Psychiatrica Scandinavica
Publisher
Wiley
Published
2012-12-14
Volume
127
Issue
2
Pages
94-114
ISSN
  • 0001-690X (ISSN-L)
  • 1600-0447
OpenAlex
W2023682546
Cited by
158
References
158
Citations by year
2026: 2 · 2025: 6 · 2024: 12 · 2023: 11 · 2022: 5 · 2021: 8 · 2020: 9 · 2019: 12 · 2018: 7 · 2017: 13 · 2016: 17 · 2015: 20 · 2014: 18 · 2013: 18
FWCI
2.76
Type
journal article
Language
en
Open access
Locations
  • Acta Psychiatrica Scandinavica (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000161, KL2TR000160)
  • National Institute of Mental Health (K23MH097794, L30 MH104713)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
Keywords
antidepressant use in pregnancy, maternal depression, maternal anxiety, teratogenicity, persistent pulmonary hypertension of the newborn, prenatal drug exposure, study design limitations, clinical guidelines
MeSH terms
Abnormalities, Drug-Induced, Antidepressive Agents, Depressive Disorder, Female, Humans, Infant, Newborn, Persistent Fetal Circulation Syndrome, Pregnancy, Pregnancy Complications, Pregnancy Trimester, First, Prenatal Exposure Delayed Effects, Risk Factors, Selective Serotonin Reuptake Inhibitors, Paroxetine

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