01. Neonatal and Pregnancy Complications Following Maternal Depression or Antidepressant Exposure

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Hello, I’m Dr. Lauren Osborne, a reproductive psychiatrist and Vice Chair of Clinical Research in Obstetrics and Gynecology at Weill Cornell Medicine. Today, I’ll discuss a new paper by Su et al. published in the Asian Journal of Psychiatry titled “Neonatal and Pregnancy Complications Following Maternal Depression or Antidepressant Exposure: A Population-Based, Retrospective Birth Cohort Study.”

Why is this paper significant? Perinatal mood and anxiety disorders are the most common complications of childbirth. They affect 15%–20% of mothers in the United States and more in low- and middle-income countries. Unfortunately, only 6% of women with antenatal depression and 3% of women with postpartum depression receive adequate treatment. Untreated disorders can negatively impact both the mother and the child. These disorders can lead to poor child development—cognitively, emotionally, and socially. They might also lead to long-term depression for mothers and, in the worst cases, are associated with suicide. Mental health conditions, including suicide and substance use, are the leading causes of pregnancy-related deaths. The high U.S. maternal mortality rate compared with other developed countries highlights the urgency of this issue.

This paper’s focus is on antidepressant use during pregnancy. Earlier studies compared women taking antidepressants during pregnancy with healthy women who didn’t do so. This is an inaccurate comparison, as women on antidepressants are managing a medical condition—depression. Recent studies have evolved, comparing women on antidepressants with those who are depressed but are not on any medication.

This paper analyzed a Taiwanese national database of nearly 2 million births. They studied 3 groups: Those without any antidepressant exposure, those with depression but without antidepressant exposure, and those with depression and antidepressant exposure. This dataset’s strength is its attempt to control by indication. Their definition of depression was also stringent, excluding cases with less than 3 outpatient visits or without a hospital diagnosis. This ensures the counted depression cases are genuine.

However, there are strengths and weaknesses. A strength is the large dataset. Yet, it’s also a weakness when delving into rare complications with smaller numbers, potentially lacking the power for accurate findings.

Their findings revealed that mothers with depression but without antidepressant exposure had higher risks of intrauterine growth restriction and preterm delivery vs mothers without depression—a commonly accepted finding. In depressed mothers, antidepressant exposure before or during the first trimester showed increased risks of gestational diabetes, malpresentation, preterm delivery, and cardiovascular anomalies. Exposure later in pregnancy showed risks of anemia, lower Apgar scores, preterm delivery, and genitourinary defects. However, it’s crucial to note that some complications had minimal cases, potentially reducing the accuracy of the findings. Moreover, the dataset lacked information on factors like alcohol use, smoking, and body weight, which might differ between the groups.

In conclusion, this article doesn’t necessarily change our prescribing patterns. We understand that perinatal mood and anxiety disorders can be severe, and this article doesn’t heighten our concerns. Although the risks of certain anomalies, like low Apgar scores, are linked with second-trimester antidepressant use, these might be statistical anomalies based on small sample sizes. Therefore, this article should reassure us that the risks tied to prescribing antidepressants aren’t substantial, but the risks of withholding them are.

Thank you for your time and focus on this crucial topic.

Abstract

Neonatal and Pregnancy Complications Following Maternal Depression or Antidepressant Exposure: A Population-Based, Retrospective Birth Cohort Study

Jian-An Su, Chih-Cheng Chang, Yao-Hsu Yang, Chuan-Pin Lee, Ko-Jung Chen, Chung-Ying Lin

Objectives: Depression is common during pregnancy, and antidepressants are often prescribed for treatment. However, depression and antidepressant use both increase the risk of neonatal and pregnancy complications. To separately evaluate the effects of antidepressant use and the underlying depression on pregnancy and neonatal complications by using a robust statistical method to control for confounding by indication.

Methods: All study data were obtained from Taiwan’s National Health Insurance Research Database. Pregnant women were divided into three groups: those with no depression and no antidepressant exposure(n = 1619,198), depression and no antidepressant exposure(n = 2006), and depression and antidepressant exposure(n = 7857). Antidepressant exposure was further divided into that before pregnancy and during each trimester.

Results: Mothers with depression but no antidepressant exposure exhibited increased risks of intrauterine growth restriction and preterm delivery, compared with mothers without depression. In mothers with depression, antidepressant exposure before pregnancy or during the first trimester conferred increased risks of gestational diabetes mellitus, malpresentation, preterm delivery and cardiovascular anomalies, compared with no antidepressant exposure. Moreover, antidepressant exposure during the second or third trimester conferred increased risks of anemia, a low Apgar score, preterm delivery and genitourinary defects. However, antidepressants administered before pregnancy and during all trimesters did not increase the risk of stillbirth.

Conclusion: Depression and antidepressant treatment for depression during pregnancy may individually increase the risks of some neonatal and pregnancy complications. Physicians should thoroughly consider the risks and benefits for both the mother and fetus when treating depression during pregnancy by using antidepressants.

Reference

Su, J. A., Chang, C. C., Yang, Y. H., Lee, C. P., Chen, K. J., & Lin, C. Y. (2023). Neonatal and pregnancy complications following maternal depression or antidepressant exposure: A population-based, retrospective birth cohort study. Asian Journal of Psychiatry, 84, 103545.