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Antidepressant use during pregnancy

NEW YORK (Reuters Health) Aug 16 - Antidepressant use during pregnancy, but not depression itself, is associated with lower gestational age at birth and an increased risk of preterm birth, according to results of a study published in the August issue of the American Journal of Psychiatry.

"Depressive symptoms are not uncommon during pregnancy, and ... symptoms may occur more frequently during pregnancy than in the postpartum period," write Dr. Rita Suri and colleagues from the University of California, Los Angeles. "Antenatal depression is not necessarily benign; it has been associated with low maternal weight gain, increased frequency of cigarette, alcohol, and substance use, and ambivalence about the pregnancy."

The researchers examined the effects of maternal depression and antenatal antidepressant use on infant gestational age at birth and risk of preterm birth in a prospective study involving 90 pregnant women. The women were divided into three groups: group 1 comprised 49 women with major depressive disorder who were treated with antidepressant medication for more than 50% of their pregnancy; group 2 comprised 22 women with major depressive disorder who were either not treated with antidepressants or had only brief exposure to them during pregnancy; and group 3 comprised 19 healthy comparison subjects. The mean gestational ages at birth were 38.5, 39.4, and 39.7 weeks for groups 1, 2, and 3, respectively. The groups differed significantly in the rates of preterm birth (14.3%, 0%, and 5.3% for groups 1, 2, and 3) and in rates of admission to the special care nursery (21%, 9%, and 0). No significant between-group differences were observed in infant birth weight or Apgar scores.

Based on those figures, the presence of depression per se during pregnancy did not adversely affect outcomes. "This result was surprising to us, as we had anticipated that depression and anxiety during pregnancy would be associated with an increased risk of preterm birth," Dr. Suri and colleagues write. "The two groups of women with depression -- those who were treated with antidepressants and those who were not -- had similar degrees of depression and anxiety during pregnancy," they note. "Thus, we found that antidepressant use, not mild to moderate depression, was associated with lower gestational age at birth and an increased risk of preterm birth." Am J Psychiatry 2007;164:1206-1213.