According to research published online ahead of print in March 2014, women who take antidepressants during pregnancy are more likely to deliver their babies prematurely than women who don’t take them.
Lead author of the study Krista Huybrechts, MS PhD from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital and Harvard Medical School said the number of women using antidepressants whilst pregnant has increased over the past twenty years.
“Preterm birth is a major clinical problem throughout the world and rates have been increasing over the past two decades. At the same time, rates of antidepressant use during pregnancy have increased approximately four-fold,” said Dr Huybrechts.
41 papers studied
According to senior Author Dr Adam Urato, they found a link between antidepressants and preterm birth.
“We studied 41 papers on this topic and found that the available scientific evidence is becoming clearer that antidepressant use in pregnancy is associated with preterm birth”.
Could depression be the culprit?
“The complication of preterm birth does not appear to be due to the maternal depression, but rather it appears likely to be a medication effect” said Dr Urato.
SSRIs and autism link
A study by John Hopkins Bloomberg School of Public Health revealed that when antidepressants called SSRIs are taken during pregnancy, there is a higher risk of autism and developmental delays.
SSRI’s or Selective Serotonin Reuptake Inhibitors work by increasing the levels of Serotonin (a feel good hormone) in the brain by inhibiting the mechanisms that naturally absorbs serotonin.
The autism link, which was published in the online Journal Pediatrics, involved researchers looking at almost 1,000 children, most of them boys, who had Autism and developmental delays and also children with typical development.
Boys affected more
The researchers found gender differences in the effect of prenatal exposure to anti depressants with boys being more likely to be affected than girls.
“We found prenatal SSRI exposure was almost three times as likely in boys with autism spectrum disorders relative to typical development, with the greatest risk when exposure is during the first trimester,” said study co-author Li-Ching Lee, an associate scientist in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, in Baltimore.
Should women stop taking their meds?
No, say some experts, as the risks are low and it’s important to treat depression in pregnant women. Others aren’t so sure. Although medication may be the only option for severe depression, other safer alternatives may be a better option for milder cases.
What about whilst breastfeeding?
Research presented at the 18th Perinatal Society of Australia and New Zealand annual conference in Perth, explained that women are more likely to continue breastfeeding if they continue taking their antidepressants.
Research carried out by Adelaide University found that 67 percent of women stopped taking antidepressants before becoming pregnant or when they started to breastfeed. The remaining 33 percent continued to take their antidepressant medication throughout pregnancy and while breastfeeding and they breastfed for longer.
“These women were much more successful at maintaining breastfeeding up to and beyond the recommended 6 months” explained Dr Luke Grzeskowiak who led the research.
Dr Grzeskowiak and his colleagues maintain that women should be supported and encouraged by health care providers, as well as family and friends to continue with their medication.
Unfortunately there isn’t an exact science to weigh up the benefits of taking antidepressant medication during pregnancy and whilst breastfeeding, against the risks to the baby. Of the numerous studies carried out, many carry conflicting results leaving women and even some doctors unsure of whether medication is really safe.
According to a research study by Filomina Fortinguerra et al and published in Pediatrics in October 2009, the main concern about taking SSRIs whilst breastfeeding, is whether long term exposure may have long term neurobehavioural effects as most of the studies carried out so far have been short term studies.
This research report also said that Fluoxetine (Prozac) was contraindicated whilst breastfeeding. However, another research study by Professor Louis Appleby et al and published in the British Medical Journal found Prozac to be an effective treatment for women with Post Natal Depression.
Just to confuse the matter even more, NICE (National Institute for Health and Care Excellence) advises that Prozac is not recommended whilst breasting unless a woman has already been taking it without any problems during pregnancy.
Best for baby
The most important thing for anyone suffering from depression or considering medication options whilst pregnant or breastfeeding is to discuss their case and all their symptoms with a qualified health care provider. Some women with severe depression will almost certainly need to take medication to keep their depression under control and in these cases this would be in the best interests of the baby too.
However, for many, particularly those with mild depression, it may be that with support and possibly alternative treatments like psychotherapy or natural remedies that the depression is completely manageable without antidepressants and this would be ideally be the best option for baby.