Antidepressants in Pregnancy

Scientific evidence regarding whether potential adverse effects for the offspring or mother exist following antidepressant exposure during pregnancy continues to evolve and remains conflicting at times. Diverse outcomes are confounded by many variables limiting interpretation of results, the major of which is the severity of the psychiatric illness which itself has adverse effects on similar outcomes as those studied for antidepressants. These medications do not appear to affect women’s ability to get pregnant, nor do they lead to spontaneous abortion. They are not major teratogens, and recent data do not support an association with cardiac anomalies after accounting for confounds overall. Exposure in utero is associated with a small effect on gestational age, low birth weight, preterm birth, and APGAR scores. PNAS has been consistently reported, but typically the signs are transient. Whether there is an increased risk for autism spectrum disorders is uncertain as well as for ADHD. Antidepressants appear to increase the risk for postpartum hemorrhage, but with other negative maternal outcomes, the association is not clear nor is the clinical significance. Antidepressants other than SSRIs have been less researched and sample sizes are small, but typically the same issues are present.