Are antidepressants safe in the first trimester of pregnancy?

Effect of Maternal Antidepressant Use During the Pre-pregnancy/Early Pregnancy Period on Congenital Heart Disease: A Prospective Cohort Study in Central China

Background

With the increase in maternal antidepressant prescribing before/during pregnancy, concerns about the safety of antidepressants have come into focus. The purpose of this study was to explore the association between maternal antidepressant use before pregnancy/in early pregnancy and the risk of congenital heart disease (CHD) in children, and to provide a scientific basis for clinical safety of antidepressant use.

Methods

The prospective cohort study ultimately included 34,104 singleton pregnancies. Modified Poisson regression model with robust error variances was used to evaluate RRs and 95% confidence intervals (CIs) for the risk of CHD in offspring exposed to maternal antidepressant in the 3 months before pregnancy and early pregnancy. In addition, sensitivity analysis was further performed to explore the robustness of the results.

Results

In this study, the maternal antidepressant exposure rate was 2.83% in the 3 months before pregnancy, 2.42% in early pregnancy, and the incidence of CHD was 8.973 per 1,000 live births. We found that maternal antidepressant use in the 3 months before pregnancy and early pregnancy were all associated with an increased risk of CHD, ~2.54 times and 2.87 times, respectively, of non-use of antidepressants after adjusting for potential confounders. This association was also found in CHD specific phenotypic analysis. Of these, offspring whose mothers were exposed to antidepressants in the 3 months before pregnancy had the highest risk of transposition of the great arteries (aOR = 5.50, 95% CI: 1.91–15.88). The offspring of mothers exposed to antidepressants in early pregnancy had the highest risk of developing ventricular septal defect (aOR = 4.80, 95% CI: 2.50–9.24). Sensitivity analysis verified the stability of the results.

Conclusions

Maternal antidepressant use in the 3 months before pregnancy and early pregnancy were all associated with an increased risk of CHD in their offspring. In order to reduce the risk of teratogenesis, we recommend that pregnant women prepare for pregnancy after their condition improves or receive the minimum effective dose of medication.

Systematic Review of Prevalence of Antepartum Depression during the Trimesters of Pregnancy

BACKGROUND

Depression is prevalent during antenatal and postnatal stages of pregnancy. The effect of depression can be seen in complications during and after pregnancy, fetal growth retardation, abortions and preterm births. The literature abounds on postpartum depression (PD) while few studies are on antepartum depression (AD).

AIM

The systematic review aims to compute the prevalence of AD from published articles.

MATERIAL AND METHODS

The published articles (26) used in this review were obtained from the search of the search keywords "Depressive conditions in pregnancy AND trimesters". All the articles were considered irrespective of language and their citation status as of the time of the query. Only articles that presented the prevalence mean and sample size were included. Articles on questionnaires filled by nonpregnant women and men were excluded. Articles that presented the prevalence of depression for the postpartum period only were excluded but were included if they addressed depression at both postpartum and trimester(s) of pregnancy. P-value of less than or equal to 0.05 was considered significant.

RESULTS

Analysis of the 26 articles showed that 4,303 subjects tested positive for depression in a sample of 28,248 pregnant mothers, giving the prevalence rate as 15%. Confounding was removed, and the sample size was adjusted to be 25,771 and 4,223 were screened to have depressive symptoms, thereby giving a new prevalence rate as 16.4%. It was also revealed that AD is most prevalent in the last trimester of pregnancy and least in the second trimester. Pregnancy duration and PD are not correlated with AD. This implies that AD can be observed in any period of the pregnancy and cannot predict the incidence of PD.

CONCLUSION

Efforts must be intensified to monitor pregnant women during the third trimester to reduce the incidence of maternal depression during pregnancy, thereby reducing the prevalence.