Context Despite the frequency of depression in women of childbearing age, information
to guide patients and physicians through a consideration of treatment during
pregnancy is limited.
Objective To identify risk factors associated with treatment of major depression
during pregnancy to help physicians develop treatment plans that optimize
Data Sources Reports of prospective controlled trials in English were identified
from MEDLINE and Health STAR using the search terms antidepressant
during pregnancy and depression during pregnancy, by manually searching bibliographies of review articles, and through
discussions with investigators for 1989-1999.
Study Selection We selected studies in which maternal and infant health outcomes associated
with antidepressant exposure were compared with those of nonteratogen-exposed
controls. Four studies published since 1993 were identified and included in
Data Extraction We abstracted information about identification of subjects, comparison
groups, pregnancy, and birth outcomes. We organized the data along 5 domains
of reproductive toxicity: intrauterine fetal death, morphologic teratogenicity,
growth impairment, behavioral teratogenicity, and neonatal toxicity.
Data Synthesis Data were available for tricyclic antidepressants (collectively), fluoxetine,
and newer selective serotonin reuptake inhibitors (collectively). Exposure
to these agents did not increase risk for intrauterine death or major birth
defects. Decreased birth weights of infants exposed to fluoxetine in the third
trimester were identified in 1 study. The development of children whose mothers
took tricyclics or fluoxetine during gestation did not differ from that of
controls. Direct drug effects and withdrawal syndromes occurred in some neonates
whose mothers were treated with antidepressants near term.
Conclusions Although few in number, new information from prospective studies provides
a welcome change from decision making based on nonprospective data. Monitoring
and interventions for patients with identified risks (eg, poor weight gain)