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Joan Vos MacDonald is a freelance writer living in upstate New York.
Antidepressant use during the first trimester does not increase incidence of ADHD or autism spectrum disorder.
Antidepressants are used by 12.7% of the U.S. population over 12. Since many women taking antidepressants are of childbearing age, pregnancy may prompt a discussion on whether to continue drug treatment for the duration. The risks and benefits continuing antidepressant drugs have been explored in many studies, but finding definitive links is complicated by the fact that pregnant women are excluded from randomized clinical trials.
A retrospective study has looked at the experience of women who took antidepressants during the first trimester to determine if medication use increased incidence of preterm birth, low birth weight, or a higher incidence of autism spectrum disorder or attention-deficit/hyperactivity disorder in offspring. The study measured the births and outcomes of children born to antidepressant users against the experience of their siblings, which helped control for genetic influences.
The study found a slight increase in preterm births associated with antidepressant use but no significant increase in low birth weight, ADHD, or autism spectrum disorder, when considering the experience of siblings. Although preterm birth rates were higher, untreated major depression can also lead to preterm birth.
“The challenge with any retrospective study is controlling for confounders in the data,” said Sarah Westberg, PharmD, FCCP, BCPS. “The authors in this study did a good job of considering confounding data, she noted. “It is
Darah Westberg, PharmDdifficult to enroll pregnant women in prospectively controlled trials, due to the desires of patients and health care providers to clearly weigh known risks and benefits to the mother and developing fetus.”
“Untreated major depression in pregnancy may increase the risk of preterm birth and other poor birth outcomes,” said Westberg. “Therefore, we have to balance the risks and benefits of medication use during pregnancy and the risks of uncontrolled depression in pregnancy.”
Since the study was focused on the first trimester, it could not determine whether later use had a significant effect. Also, all antidepressants are not considered equal in terms of risk to the fetus,” she told Drug Topics.
“Much of the data on antidepressant use in pregnancy focuses on SSRIs, because this is the most widely used class of antidepressants (and was 82% of the antidepressants used in this study). Newer antidepressants and non-SSRI antidepressants are less studied, so we have less information on the risk and benefit balance”
Pharmacists should evaluate a patient’s circumstances when counseling pregnant patients with depression, Westberg said. “It's important for pharmacists to understand the woman's specific history and situation, so that holistic, patient-centered education can be provided.”