Selective serotonin reuptake inhibitor exposure in pregnancy and neonatal adverse events

Cardiac dysfunction and prenatal exposure to venlafaxine

Venlofaxine, a widely used antidepressant, is known to cause a withdrawal syndrome. We present a case of neonatal transient ventricular dysfunction in a neonate exposed to venlafaxine in utero. Other causes of ventricular dysfunction were excluded. Neonatal ventricular dysfunction can be a possible side effect of maternal use of this drug.

Disparities in antidepressant use in pregnancy

OBJECTIVE

The American College of Obstetricians and Gynecologists and the American Psychiatric Association both recommend pharmacotherapy for perinatal depression when the benefits outweigh the risks. While minority adults are less likely to use antidepressant medications compared with non-Hispanic Whites, whether this pattern occurs among pregnant women is unclear. We sought to determine the frequency of antidepressant medication use reported during ambulatory care visits for pregnant women and whether these rates varied by race.

STUDY DESIGN

We combined the 2006-2010 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to obtain nationally representative estimates of outpatient preventive care visits for pregnant women. We then obtained estimates of the prevalence of reported depression and antidepressant use during outpatient visits for pregnant women. To determine whether these estimates varied by race, we used multivariable logistic regression analyses accounting for survey design using SAS 9.2 (PROC SURVEYLOGISTIC) to estimate odds ratios of reported antidepressant use after adjustment for age, insurance status and region of the country.

RESULT

Antidepressant use was reported during 2.2% of all outpatient visits for pregnant women. Providers indicated a depression diagnosis in 4.5% of visits. Among visits for depressed pregnant women, providers reported antidepressant use 25.4% of the time for all visits. Antidepressant use during pregnancy varied significantly by race/ethnicity. Among visits for non-Hispanic White women, 3.1% included a code for antidepressant use vs just 1.0% for non-White women (P<0.0001). After adjustment for age, insurance status and region of the country, this association persisted with non-Hispanic White (vs non-White) pregnant women having higher odds of antidepressant use (adjusted OR 3.3, 95% confidence intervals 2.1, 5.3).

CONCLUSION

Non-Hispanic White women were more likely than non-White women to be using antidepressants during pregnancy. Whether differences in antidepressant use by race/ethnicity indicates over-treatment of non-Hispanic White women or under-treatment of minorities remains unclear. This disparity warrants investigation with the goal of optimizing maternal mental health while minimizing potential adverse sequelae of antidepressants on developing fetuses.

The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond

STUDY QUESTION

What is the current literature on the safety and efficacy of selective serotonin reuptake inhibitor (SSRI) use in infertile women?

SUMMARY ANSWER

There is little evidence that infertile women benefit from taking an SSRI, therefore they should be counseled appropriately about the risks and be advised to consider alternate safer treatments to treat depressive symptoms.

WHAT IS KNOWN ALREADY

SSRI use is associated with possible reduced infertility treatment efficacy as well as higher rates of pregnancy loss, preterm birth, pregnancy complications, neonatal issues and long-term neurobehavioral abnormalities in offspring.

STUDY DESIGN, SIZE, DURATION

Review of existing literature.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We conducted a review of all published studies that evaluate females with depressive symptoms who are taking antidepressant medications and who are experiencing infertility.

MAIN RESULTS AND THE ROLE OF CHANCE

Antidepressant use during pregnancy is associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects. There is no evidence of improved pregnancy outcomes with antidepressant use. There is some evidence that psychotherapy, including cognitive-behavioral therapy as well as physical exercise, is associated with significant decreases in depressive symptoms in the general population; research indicates that some forms of counseling are effective in treating depressive symptoms in infertile women.

LIMITATIONS, REASONS FOR CAUTION

Our findings are limited by the availability of published studies in the field, which are often retrospective and of small size.

WIDER IMPLICATIONS OF THE FINDINGS

Practitioners who care for infertility patients should have a thorough understanding of the published literature so that they can adequately counsel their patients.

STUDY FUNDING/COMPETING INTEREST(S)

None.