Main Article Content

Asnat Walfisch


Depression, teratogenicity, risk, antidepressant therapy, exposure, pregnancy, screening


Exposure to various medications and medical conditions during pregnancy is often inevitable. Most of these exposures do not carry an elevated risk of congenital malformations. Nevertheless, misperceptions of the risks associated with different exposures in pregnancy are common and may potentially lead to wrong decisions. Unrealistically high maternal teratogenic risk perception may lead to abrupt discontinuation of therapy during pregnancy and even to termination of an otherwise wanted pregnancy.

Maternal perceptions and decisions regarding pregnancy are influenced by many factors including the emotional well-being. Maternal depressive symptomatology appears to have a significant effect on the perception of teratogenic risk and may further limit the validity of a decision-making process. Both screening and addressing maternal depression, as well as appropriate exposure related counseling by a teratology service, may help in reducing unnecessary fear of teratogenicity and possibly even the likelihood of pregnancy termination.

Abstract 11 | PDF Downloads 9


1. Bonari L, Koren G, Einarson TR, et al. Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Womens Ment Health 2005;8:214-220.
2. Koren G, Bologa M, Long D, et al. Perception of teratogenic risk by pregnant women exposed to drugs and chemicals during the first trimester. Am J Obstet Gynecol 1989;160:1190-1194.
3. Koren G, Bologa M, Pastuszak A. Women's perception of teratogenic risk. Can J Public Health 1991;82:S11-4-S33-37.
4. Nordeng H, Ystrøm E, Einarson A. Perception of risk regarding the use of medications and other exposures during pregnancy. Eur J Clin Pharmacol 2010;66:207-214.
5. De Santis M, De Luca C, Quattrocchi T, et al. Use of the Internet by women seeking information about potentially teratogenic agents. Eur J Obstet Gyneco Reprod Biol 2010;151:154-157.
6. Einarson A, Selby P, Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counseling. J Psychiatry Neurosci 2001;26:44-48.
7. Cohen LS, Altshuler LL, Harlow BL, et al. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA 2006;295(5):499-507.
8. Walfisch A, Sermer C, Matok I, Einarson A, Koren G. Perception of teratogenic risk and the rated likelihood of pregnancy termination: association with maternal depression. Can J Psychiatry 2011; 56(12):761-7.
9. National Mental Health Association: Depression in women. Available at: (Accessed April 15, 2004)
10. Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 2008;65:805-815.
11. Marcus SM, Flynn HA, Blow FC, Barry KL. Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health 2003;12:373-380.
12. Kessler RC, McGonagle KA, Swartz M, Blazer DG, Nelson CB. Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence. J Affect Disord 1993; 29(2-3):85-96.
13. Ahokas A, Kaukoranta J, Aito M. Effect of oestradiol on postpartum depression. Psychopharmacology 1999;146:108.
14. Dennis CL, Ross LE, Grigoriadis S. Psychosocial and psychological interventions for treating antenatal depression. Cochrane Database Syst Rev 3:CD006309, 2007.
15. Pagel MD, Smilkstein G, Regen H, et al. Psychosocial influences on new born outcome: a controlled prospective study. Soc Sci Med 1990;30:597-604.
16. Hedegaard M, Henriksen TB, Sabroe S, et al. Psychological distress in pregnancy and preterm delivery. BMJ 1993;307:234-239.
17. Teixeira JMA, Fisk NM, Glover V. Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. BMJ 1999;318:153-157.
18. Muzik M, Marcus SM, Heringhausen JE, et al. When depression complicates childbearing: guidelines for screening and treatment during antenatal and postpartum obstetric care. Obstet Gynecol Clin North Am 2009;36:771- 788.
19. Alder J, Fink N, Urech C, et al. Identification of antenatal depression in obstetric care. Arch Gynecol Obstet 2011;284(6):1403-9.
20. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10- item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782–786.
21. Eberhard-Gran M, Eskild A, Tambs K, et al. Review of validation studies of the Edinburgh Postnatal Depression Scale. Acta Psychiatr Scand 2001;104:243–249.
22. Murray D, Cox JL. Screening for depression during pregnancy with the Edinburgh depression scale (EPDS). J Reprod Infant Psychol 1990;8:99-107.
23. Thorpe K. A study of the Edinburgh postnatal depression scale for use with parent groups outside the postpartum period. J Reprod Infant Psychol 1993;11:119-125.
24. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
25. Walfisch A, Sermer C, Matok I, Koren G, Einarson A. Screening for depressive symptoms. Can Fam Physician. 2011 Jul;57(7):777-8.