Antidepressant use by pregnant women in the U.S., which has skyrocketed in recent years, is being linked to a significantly increased risk of preterm birth – the leading cause of infant mortality – according to a major new study released yesterday by researchers from Boston’s famed Brigham and Women's Hospital and Tufts Medical Center as well as Vanderbilt University in Nashville.
"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," says lead author Krista Huybrechts, M.S., Ph.D., from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School. "Therefore it is essential to determine what effects these medications have on pregnancy."
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Huybrechts’ research team conducted a meta-analysis of dozens of published studies that had evaluated women who took antidepressants during their pregnancies and that included data on the babies’ gestational age at birth. Their results were published online in the peer-reviewed journal PLOS ONE.
"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," says senior author Adam Urato, M.D., a maternal-fetal medicine specialist at Tufts Medical Center and MetroWest Medical Center. "The complication of preterm birth did not appear to be due to the maternal depression, but rather it appears likely to be a medication effect."
"Several of the studies in this review controlled for maternal depression and these studies continued to show increased rates of preterm birth in the antidepressant exposed pregnancies," adds Reesha Shah Sanghani M.D., MPH, from Vanderbilt University.
"It is important to keep in mind, however, that the issue of treatment of depression during pregnancy is complex and that there are many factors to consider. Pregnant women and their providers need to weigh many issues," says Urato. "It is crucial, though, that the public gets accurate information on this topic."
Preterm birth is a big deal, the researchers point out, noting that rates of preterm birth have been increasing for the past two decades: “Children born preterm have higher infant mortality rates than full-term babies and surviving infants are at increased risk of health problems ranging from neurodevelopmental disabilities such as cerebral palsy and intellectual delays to other chronic health problems like asthma,” according to a press statement by the research team.
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In the majority of the 41 studies the authors reviewed, the rate of preterm births was elevated in pregnant women taking antidepressants, with the strongest association when they took the antidepressants during the third trimester.
"Preterm birth is the leading cause of infant death and it is also a major contributor to both short and long-term illness," says Urato. "While very preterm infants have the highest risk, we now know that even later preterm birth is associated with significant increases in neonatal morbidity and mortality."
Added Huybrechts: "Pregnant women with depression need proper treatment and our results should not be seen as an argument to ignore depression in these patients. These drugs may be necessary in some pregnant women with severe depression in whom other approaches are inadequate.”
“However,” she stressed, “for many others, non-drug treatments, such as psychotherapy, will help, and aren't associated with complications like preterm birth."
Previous studies have shown a raft of other medical complications – both to mother and child – associated with antidepressant use during pregnancy, including, as WND recently reported, an increased risk of giving birth to children with autism.