Depressed and Pregnant --> 1 in 5 Risk of Premature Birth
--SSRI use does not improve your odds much
--data suggests that something about the underlying depression affects the premature rate, regardless of SSRI TX
--"continuous" = throughout gestation
--"partial" = some of gestation with at least 1 trimester being in opposite group
--continuous SSRI use --> preterm birth risk of 21%
--continuous untreated depression --> preterm birth risk of 23%
--women with neither depression nor SSRI exposure have a preterm birth rate of 6%
--partial depression exposure --> 9% rate of preterm birth
--partial SSRI use --> 4% preterm birth rate (not sig different from no-depression/no-SSRI group)
--continuous SSRI exposure --> 5.43 times more premies than no SSRI/no depression group
--continuous depression but no SSRI exposure --> 3.71 times more premies
--either partial SSRI exposure or partial depression --> no significant change
--preterm births 2x more in African American mothers, regardless of depression and tx hx
--preterm 3.48x more women <31 years
--children of the SSRI-exposed moms --> no increase in rates of minor or major physical anomalies, no increased risk of being in intensive are, and no other differences EXCEPT FOR SLIGHTLY WORSE 5-MINUTE APGAR SCORES
--SO if you're depressed and pregnant and considering taking SSRIs, the drug doesn't make a big difference. But depression does.
--however the study numbers are too small to address the odds of major fetal abnormalities, esp cardiac malformations
--Christina Chambers (U.CA., San Diego) 1996 NEJM report raised alarm about adverse birth outcomes in pregnant women taking fluoxetine (Chambers C et al. N Engl J Med. 1996;335:1010-1015) (FLUOXETINE???)
--small risks associated with paroxetine in pregnancy (PAROXETINE???)
--wondering about other differences between those who get treated for depression and those who don't: income? class? race? parenting styles?
SOURCES:
--study published online March 16 in the American Journal of Psychiatry
--Katherine L. Wisner, MD
--University of Pittsburgh Medical Center, in PA
Am J Psychiatry. Published online March 16, 2009. Abstract
http://www.medscape.com/viewarticle/589830?src=mp&spon=12&uac=89474MT