Antidepressants in Pregnancy: Safe or Not?

Two new studies have good news for the children of women taking antidepressants during pregnancy, but a third shows some risks to the depressed moms themselves.

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If you're one of the millions of women taking medication for depression, you may be wondering if you should stop taking it during pregnancy. Previous research has been mixed about the effects of antidepressants on the baby, but two recent studies in BJOG: An International Journal of Obstetrics and Gynecology showed no long-term effects on children whose mothers took the medications during pregnancy. A third study, however, found that women's risk for postpartum hemorrhage did increase after taking antidepressants.

No issues in children prenatally exposed

As part of the large Norwegian Mother and Child Cohort Study, researchers looked at the motor skills of 51,404 three-year-olds. Moms filled out a questionnaire on their use of antidepressants known as SSRIs (selective serotonin repute inhibitors) while pregnant, and reported on their child's motor skills. "We did find a weak association between prolonged maternal use of SSRIs during pregnancy and delayed motor development in the child," lead author Marte Handal, Ph.D., of the Norwegian Institute of Public Health tells Fit Pregnancy. "However, very few children fell in the category of severe motor delay."

Because the link to minor delays in motor skills was so small, Handal says that the benefits to mom's health in taking antidepressants outweigh this risk to the child. "These results should not lead clinicians to be reluctant to initiate or continue antidepressant treatment in pregnant women who are in need of it," she says. "The absolute risk of delayed motor development is so low that this should not discourage pregnant women from using SSRIs."

Another study analyzed data from 49,000 women registered on the Danish National Birth Cohort to see if prenatal exposure to antidepressants had any effect on behavioral problems in seven-year-old children. "What we found was that children of mothers taking antidepressants during pregnancy were not more likely to have behavioral problems, which is quite reassuring," lead author Luke Grzeskowiak, Ph.D., of The University of Adelaide, Australia, tells Fit Pregnancy. In fact, the results showed that untreated prenatal depression in pregnancy was actually linked to increased risk of behavior issues. "For all of the outcomes studied, a greater proportion of behavioral problems were identified in the children of mothers with non-medicated depression, highlighting that underlying maternal illness is likely to be a key factor involved in influencing immediate and long-term outcomes," Grzeskowiak says.

Mom might face increased risks

A third study, though, did show one negative effect of antidepressants taken in late pregnancy: an increased risk for postpartum hemorrhage. This research, also led by Grzeskowiak, showed that the chances of this excessive bleeding increased from 11 percent to 16 percent, and the risk of it being severe almost doubled, from five to nine percent. But, "we only looked at the risk of bleeding associated with use of antidepressants late in pregnancy, so cannot report on the risks associated with use earlier in pregnancy," Grzeskowiak says, noting that a previous study showed no increased risk for moms who stopped one month prior to baby's birth.

Even with these results, Grzeskowiak does not necessarily advise stopping medication, especially without first talking to your doctor. "Overall, while women and their doctors should be aware of the potential increased risk of bleeding associated with delivery, we advise caution against women stopping their antidepressants close to delivery, as this may be associated with a worsening of their illness at this critical time of maternal-infant bonding following delivery," he says. "The potential increased risk of bleeding [is] best managed by delivering in an appropriate hospital setting where doctors are available to assist where required."

Coming up with a plan that's right for you

If you're currently taking an antidepressant, talk to your doctor to decide whether you should continue your medication during pregnancy. "I would advise pregnant women to take SSRIs during pregnancy if their doctors believe that such treatment is necessary to treat their depression," Handal says. Although this new research lends support to sticking with the meds, Grzeskowiak says that each patient's plan should be individualized. "The key take-away message for newly pregnant women is to have an open conversation about their mental health illness with their healthcare professional," Grzeskowiak says. "It is really important that each woman is managed on a case by case basis, which makes it difficult to make general recommendations."

Moms-to-be are more likely to worry about adverse effects on their baby rather than themselves, so it's good news that these studies showed no long-term harm on children from taking SSRIs. But taking care of yourself and your own mental health is what's best your baby, too. "Depression may result in serious adverse outcomes for the pregnant woman herself, and because of this it is important that she receives pharmacological treatment when necessary," Handal says.

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