For years, obstetricians have worried about whether women suffering from depression during pregnancy should be prescribed antidepressant drugs.
On the one hand, depression during pregnancy has been associated with poor weight gain and inadequate self-care, possibly increasing the risks of complications.On the other hand, no one wants to expose a fetus to powerful medications such as SSRI antidepressants like fluoxetine (Prozac) or sertraline (Zoloft) unnecessarily. The risks of such in-utero exposure have been debated.
Three Million Pregnancies
Now, scientists have examined the health records of more than three million pregnant women on Medicaid in the US. What they found is that there is an increased risk of a serious complication for newborns when their mothers take SSRI-type antidepressants in pregnancy, especially in the later stages.
Persistent Pulmonary Hypertension
The babies are slightly more susceptible to persistent pulmonary hypertension. In this condition, babies have difficulty breathing within hours of birth and may need to be put on a ventilator. This can be lethal or lead to lasting problems throughout life, such as seizures or lung disease.
In this analysis, just over 100,000 women filled prescriptions for SSRI antidepressants during their third trimester. The likelihood of a baby born to one of these mothers having pulmonary hypertension was 31.5 in 10,000. That compares to the risk for a baby born to a mother not taking any antidepressant, which was 20.8 in 10,000. Thus, the difference was about 10 in 10,000 or roughly 1 in 1,000. Even though that is a 28 percent increased relative risk, it is a pretty small increase overall.
The Doctors’ Dilemma
Doctors will be faced with the dilemma of evaluating whether the benefits for both mother and baby of treating her depression are greater than the still-modest increase in the risk of persistent pulmonary hypertension in the newborn. On a case by case basis, it may come down to the question of how severe and debilitating her psychological condition is. In mild depression, other approaches to managing the mother’s distress may provide relief without adding to the risk or the anxiety that the newborn infant will suffer a potentially life-threatening complication.
