Depression during Pregnancy

by Ren Chats
(Denmark)

Selective serotonin reuptake inhibitors (SSRIs) prescribed for depression during pregnancy do not increase risk of stillbirth and infant mortality concludes a large study published on Jan 02’ 2013 in the Journal of the American Medical Association (JAMA)

The study

It is the combined analysis of individual studies done by Denmark, Finland, Iceland, Norway, and Sweden over a span of 10 years (1996 – 2007).

The study involved total of more than 1.6 million babies (twins and triplets were not included in the study), of which almost 30 thousand of mothers were on prescribed SSRIs therapy during the pregnancy.

Though the rate of stillbirths in the study was noted to be a shade higher in mothers on SSRIs therapy than those not, yet it was not significant enough to be associated with use of SSRIs during pregnancy.

“No significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or post neonatal mortality. However, decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness,” the study concluded.

Mother's psychological state affects newborn's health

There are many controversies that surround the underlying cause for the health hazards in babies born to the mothers with disturbed emotional state.

Some of the known factors are given below:

1. Mental health of the parents

2. Parents' social and emotional well being

3. Genetic predisposition

4. Drugs administered to mother

5. Mother's lifestyle - stress, alcohol consumption, smoking and so on.

Treatment of depression during pregnancy is a medical challenge

Treatment of depression in a pregnant woman demands drug therapy, which is easily passed on to her baby in the womb. Risks and benefit of the therapy therefore need to be weighed very closely: The effect of maternal depression on the baby in the womb is noticeable during infancy and childhood as emotional and behavioral instability.
Depression around pregnancy

Depression during and after pregnancy is common; almost every fifth pregnant women suffers from depression.

Stress and depression during pregnancy increase stress hormone levels in the mother and thereby disturb fetal hormones.

Consequently, fetal development is jeopardized and the risk of premature birth rises along with associated several health risks of the newborn.

SSRIs taken by mother affect the fetus and the newborn

Selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline, citalopram, fluvoxamine) are commonly used to treat maternal depression during pregnancy and also later during the lactation phase (postpartum depression).

Though SSRIs taken by the mother cross placenta freely and are also secreted in mother’s milk, they have proved to be the safest.

Known undesirable effects of SSRIs on the fetus and the newborn

1. Poor neonatal adaptation: over stimulation (serotonin syndrome) or withdrawal (serotonin discontinuation syndrome)

2. Neonatal behavioral syndrome is characterized by central nervous system (irritability, excess or restless sleep), motor (agitation, tremor, hyperreflexia, rigidity, hypotonia or hypertonia), respiratory (nasal congestion, respiratory distress, tachypnea), gastrointestinal (diarrhea, emesis, poor feeding) and systemic (hypothermia or hyperthermia, hypoglycemia) manifestations.

Most infants have only mild symptoms that resolve within 2 weeks. Severe syndrome characterized by seizures, dehydration, weight loss, hyperpyrexia, and respiratory failure is seen only in 1% of the cases.

No deaths have been reported. Treatment is directed at the individual manifestations and accompanied by supportive therapies.

3. Long term neuro-developmental outcomes.

4. Small increased risk of congenital anomalies.

5. Neonatal withdrawal syndrome.

6. Persistent pulmonary hypertension of the newborn.

7. Jitteriness and heightened startle response.

Reference

Selective Serotonin Reuptake Inhibitors During Pregnancy and Risk of Stillbirth and Infant Mortality:Olof Stephansson, MD, PhD; Helle Kieler, MD, PhD; Bengt Haglund, PhD; Miia Artama, PhD; Anders Engeland, PhD; Kari Furu, PhD; Mika Gissler, PhD; Mette Nørgaard, MD, PhD; Rikke Beck Nielsen, MSc; Helga Zoega, PhD; Unnur Valdimarsdóttir, PhD - JAMA. 2013;309(1):48-54. doi:10.1001/jama.2012.153812.