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Antidepressants, pregnancy, preterm delivery, Motherisk Program
A single study has been published documenting an increased risk for adverse pregnancy outcomes following use of more than one antidepressant during pregnancy.
To examine whether multiple antidepressant use is associated with increased rates of major malformations, spontaneous abortions (SA), therapeutic abortions (TA), stillbirths, preterm birth, low birth weight, small for gestational age (SGA) and admission to the neonatal intensive care unit (NICU).
Information from the Motherisk Program’s prospectively collected database of 1243 women with gestational exposure to antidepressants. We compared pregnancy outcomes of 89 women exposed to >1 antidepressants, 89 taking one antidepressant, and 89 women not exposed to antidepressants (n= 267). Women were matched for maternal age, smoking and alcohol use. Groups were compared using odds ratios and ANOVA.
11/89 (12%) took 3 and 78 (88%) took 2 antidepressants. There were no statistically significant differences in any of the outcomes analyzed among the 3 groups except for a lower mean gestational age at birth in the multi-antidepressant group (0.9 week, P=0.036). There were 9 admissions to NICU from the antidepressant groups and 3 from the non-exposed group; but this did not reach statistical significance.
There is a small risk of preterm delivery that is associated with exposure to antidepressant therapy, although the clinical relevance remains to be determined.
3. Alwan S, Reefhuis J, Rasmussen SA, Olney RS, Friedman JM. National birth defects prevention study. N Engl J Med 2007;356:2684-92.
4. Einarson A, Choi J, Einarson TR, Koren G. Incidence of major malformations in infants following antidepressant exposure in pregnancy: results of a large prospective cohort study. Can J Psychiatry 2009;54:242-6.
5. Einarson A, Choi J, Einarson TR, Koren G. Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database. J Obstet Gynaecol Can 2009;31:452-6.
6. Wisner KL, Sit DK, Hanusa BH, et al. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry 2009;166:557-66.
7. Koren G, Boucher N. Adverse effects in neonates exposed to SSRIs and SNRI in late gestation. Can J Clin Pharmacol 2009;(1):e66-7.
8. Kallén B, Otterblad Olausson P. Antidepressant drugs during pregnancy and infant congenital heart defect. Reprod Toxicol 2006;21:221-3.
9. Cole J, Ephross S, Cosmatos I, Walker A. Paroxetine in the first trimester and the prevalence of congential malformations. Pharmacoepidemiol Drug Saf 2007;16:1075-85.
10. Kallen B, Olausson P. Maternal use of selective serotonin reuptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol 2007;79:301-8.
11. Einarson A, Pistelli A, DeSantis M, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry 2008;165:749-52.
12. Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Bech BH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. BMJ 2009 Sep 23;339:b3569.
13. Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A. 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 Nov;8(4):214-20.
14. Bar-Oz B, Einarson T, Einarson A, et al. Paroxetine and congenital malformations: meta- Analysis and consideration of potential confounding factors. Clin Ther 2007 May;29(5):918-26.
15. Suri R, Altshuler L, Hellemann G, Burt VK, Aquino A, Mintz J. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry 2007;164:1206-13.
16. Li D, Liu L, Odouli R. Presence of depressive symptoms during early pregnancy and the risk of preterm delivery: a prospective cohort study. Hum Reprod 2009;24:146-53.
17. Tanaka T, Cho J, Einarson A, Koren G, Ito S. The incidence of poor neonatal adaptation syndrome following exposure to venlafaxine in late pregnancy. Can J Clin Pharmacol 2008;15(3):e420-781.