Antidepressants in pregnancy: a systematic review

Area of Science:

• Perinatal Psychiatry
• Reproductive Toxicology
• Developmental Pediatrics

Background:

• Psychotropic medication use during pregnancy necessitates careful evaluation of risks and benefits.
• Antidepressants are commonly prescribed, making their safety profile in pregnancy a critical concern.

Purpose of the Study:

• To critically review the literature on adverse effects of antidepressant exposure during pregnancy.
• To derive evidence-based recommendations for clinical practice regarding antidepressant use in pregnant individuals.

Main Methods:

• Systematic review of electronic databases for original research studies.
• Inclusion of cohort (prospective and retrospective) and case-control studies; no randomized controlled trials identified.
• Analysis focused on pregnancy, neonatal, and longer-term developmental outcomes.

Main Results:

• Evidence suggests an association between early pregnancy antidepressant use and congenital malformations (12/35 studies).
• Increased risks observed for spontaneous abortion (4/7 studies), preterm birth (15/19 studies), and abnormal birth weight (8/23 studies).
• Neonatal adaptation difficulties were reported in 15/17 studies; SSRI exposure and persistent pulmonary hypertension showed conflicting results.
• No significant differences in longer-term developmental outcomes were found in 6/7 studies.

Conclusions:

• While generally considered relatively safe, certain antidepressant uses in pregnancy pose risks.
• Specific concerns include higher risks of preterm birth, neonatal adaptation issues, and congenital cardiac malformations (particularly with paroxetine).
• Findings underscore the importance of individualized risk-benefit assessments for treating pregnant women with antidepressants.