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Antidepressant use during pregnancy associated with preterm birth

Women who take antidepressants during the second or third trimester of pregnancy are at increased risk of giving birth before their due date, a meta-analysis of 41 studies has found. Writing in PLOS ONE last week (26 March 2014), the researchers say that preterm birth “appears likely to be a medication effect” and should be taken into consideration when prescribing antidepressants for pregnant women.

“These drugs may be necessary in some pregnant women with severe depression in whom other approaches are inadequate. However, for many others, non-drug treatments, such as psychotherapy, will help, and aren’t associated with complications like preterm birth,” lead author Krista Huybrechts, from Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, said in a statement.

Dr Huybrechts and team pooled data from 41 studies that reported preterm birth rates in women taking antidepressants during pregnancy. They were all observational cohort studies and ranged in size from 44 to 1,618,255 participants; selective serotonin-reuptake inhibitors were the most frequently used drug class.

In pooled adjusted analyses, the odds ratio for risk of preterm delivery was 1.53 (95 per cent confidence interval 1.40–1.66) for use of antidepressants at any time during pregnancy and 1.96 (CI 1.62–2.38) for use in the third trimester. The risk was not increased for antidepressant use in the first trimester (1.16, CI 0.92–1.45).

Adjusting for a diagnosis of depression attenuated but did not eliminate the observed associations. However, the possibility of residual confounding by depression severity “cannot be completely ruled out based on the available evidence”, the researchers admit.

The researchers conclude: “While our study findings cannot prove causality, they reinforce the notion that antidepressants should not be used by pregnant women in the absence of a clear need that cannot be met through alternative approaches.”

Jane Bass, spokeswoman on women’s health for the Royal Pharmaceutical Society, said that the study offers a valuable reminder that counselling of women on long-term medicines is necessary to ensure that they understand the risks and benefits of taking their medicines during pregnancy.

She told PJ Online: “Deaths from psychiatric causes are one of the leading indirect causes in the triennial maternal mortality reports. If women [who find themselves pregnant] are concerned about the risks (for example, prematurity) without appreciating the benefits of the drugs, they may decide to suddenly stop their antidepressants, risking deterioration in their mental health.” However, she added: “Some women may be taking antidepressants unnecessarily, so regular review of their medicines could enable them to reduce and stop these drugs before they get pregnant.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11136726

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