Document Detail


Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis.
MedLine Citation:
PMID:  23446732     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: Untreated depression during pregnancy has been associated with increased morbidity and mortality for both mother and child and, as such, optimal treatment strategies are required for this population.
CONTEXT: There are conflicting data regarding potential risks of prenatal antidepressant treatment.
OBJECTIVE: To determine whether prenatal antidepressant exposure is associated with risk for selected adverse pregnancy or delivery outcomes. DATA SOURCES MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library were searched from their start dates to June 30, 2010. STUDY SELECTION English-language studies reporting outcomes associated with pharmacologic treatment during pregnancy were included. We reviewed 3074 abstracts, retrieved 735 articles, and included 23 studies in this meta-analysis.
DATA EXTRACTION: Study design, antidepressant exposure, adjustment for confounders, and study quality were extracted by 2 independent reviewers.
RESULTS: There was no significant association between antidepressant medication exposure and spontaneous abortion (odds ratio [OR], 1.47; 95% CI, 0.99 to 2.17; P = .055). Gestational age and preterm delivery were statistically significantly associated with antidepressant exposure (mean difference [MD] [weeks], -0.45; 95% CI, -0.64 to -0.25; P < .001; and OR, 1.55; 95% CI, 1.38 to 1.74; P < .001, respectively), regardless of whether the comparison group consisted of all unexposed mothers or only depressed mothers without antidepressant exposure. Antidepressant exposure during pregnancy was significantly associated with lower birth weight (MD [grams], -74; 95% CI, -117 to -31; P = .001); when this comparison group was limited to depressed mothers without antidepressant exposure, there was no longer a significant association. Antidepressant exposure was significantly associated with lower Apgar scores at 1 and 5 minutes, regardless of whether the comparison group was all mothers or only those who were depressed during pregnancy but not exposed to antidepressants.
CONCLUSIONS AND RELEVANCE: Although statistically significant associations between antidepressant exposure and pregnancy and delivery outcomes were identified, group differences were small and scores in the exposed group were typically within the normal ranges, indicating the importance of considering clinical significance. Treatment decisions must weigh the effect of untreated maternal depression against the potential adverse effects of antidepressant exposure.
Authors:
Lori E Ross; Sophie Grigoriadis; Lana Mamisashvili; Emily H Vonderporten; Michael Roerecke; Jürgen Rehm; Cindy-Lee Dennis; Gideon Koren; Meir Steiner; Patricia Mousmanis; Amy Cheung
Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  JAMA psychiatry     Volume:  70     ISSN:  2168-6238     ISO Abbreviation:  JAMA Psychiatry     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-04     Completed Date:  2013-05-31     Revised Date:  2014-01-24    
Medline Journal Info:
Nlm Unique ID:  101589550     Medline TA:  JAMA Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  436-43     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Abortion, Spontaneous / chemically induced
Antidepressive Agents / adverse effects*
Apgar Score
Female
Gestational Age
Humans
Infant, Low Birth Weight
Infant, Newborn
Pregnancy
Pregnancy Complications / drug therapy,  psychology
Pregnancy Outcome*
Premature Birth / chemically induced
Grant Support
ID/Acronym/Agency:
KRS-83127//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Antidepressive Agents
Comments/Corrections
Comment In:
Evid Based Ment Health. 2013 Aug;16(3):89   [PMID:  23810976 ]
JAMA Psychiatry. 2013 Dec;70(12):1373   [PMID:  24306812 ]
JAMA Psychiatry. 2013 Dec;70(12):1373-4   [PMID:  24306813 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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