General Hospital Psychiatry
Volume 31, Issue 5 , Pages 403-413 , September 2009

The management of depression during pregnancy: a report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists

  • Kimberly A. Yonkers, M.D.

      Affiliations

    • Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT 06510, USA
    • Department of Obstetrics and Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA
    • Corresponding Author InformationCorresponding author. Department of Psychiatry, Epidemiology and Public Health, Yale School of Medicine, New Haven, CT, USA. Fax: +1 203 764 6766.
    • ,
  • Katherine L. Wisner, M.D., MS.

      Affiliations

    • Department of Psychiatry, Obstetrics and Gynecology, Women's Behavioral, HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
    • Department of Reproductive Sciences, Epidemiology and Women's Studies, Women's Behavioral, HealthCARE, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
    • ,
  • Donna E. Stewart, M.D., FRCPC

      Affiliations

    • Departments of Psychiatry, Obstetrics and Gynecology, Family and Community Medicine, Medicine, Surgery and Anesthesia, University Health Network Women's Health Program, University of Toronto, Toronto, Ontario, Canada M5G 2C4
    • ,
  • Tim F. Oberlander, M.D., FRCPC

      Affiliations

    • Department of Pediatrics, University of British Columbia, Human Early Experience Unit, Centre for Community Child Health Research, Child and Family Research Institute, Vancouver, British Columbia, Canada V6 3V4
    • ,
  • Diana L. Dell, M.D., FACOG

      Affiliations

    • Duke University Medical Center, DUMC Box 3263, Durham, NC 27710, USA
    • ,
  • Nada Stotland, M.D., M.P.H.

      Affiliations

    • Department of Psychiatry and Obstetrics, Rush Medical College Chicago, IL 60637, USA
    • Department of Gynecology, Rush Medical College Chicago, IL 60637, USA
    • ,
  • Susan Ramin, M.D., FACOG

      Affiliations

    • The University of Texas Health Science Center at Houston, Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal–Fetal Medicine, Houston, TX 77030, USA
    • ,
  • Linda Chaudron, M.D., MS.

      Affiliations

    • Department of Psychiatry, Pediatrics and Obstetrics and Gynecology, University of Rochester, Rochester, NY 14642, USA
    • ,
  • Charles Lockwood, M.D., FACOG

      Affiliations

    • Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, PO Box 208063, New Haven, CT 06520-8063, USA

Received 10 February 2009 ,Accepted 9 April 2009.

References 

  1. Gaynes BN, et al. Perinatal depression: prevalence, screening accuracy and screening outcomes. Evid. Rep./Technol. Assess. (Summ.). 2005;1–8
  2. Cooper WO, Pont ME, Ray WA. Increasing use of antidepressants in pregnancy. Am J Obstet Gynecol. 2007;196:544.e1
  3. Kitamura T, Shima S, Sugawara M, Toda MA. Psychological and social correlates of the onset of affective disorders among pregnant women. Psychol Med. 1993;23:967–975
  4. Swallow BL, Lindow SW, Masson EA, Hay DM. Psychological health in early pregnancy: relationship with nausea and vomiting. J Obstet Gynaecol. 2004;24:28–32
  5. Sugiura-Ogasawara M, et al. Depression as a potential causal factor in subsequent miscarriage in recurrent spontaneous aborters. Hum Reprod. 2002;17:2580–2584
  6. Nakano Y, et al. Psychosocial predictors of successful delivery after unexplained recurrent spontaneous abortions: a cohort study. Acta Psychiatr Scand. 2004;109:440–446
  7. Nelson BA, McMahon K, Joffe M, Brensinger C. The effect of depressive symptoms and optimism on the risk of spontaneous abortion among innercity women. J Womens Health. 2003;12:569–576
  8. Steer RA, Scholl TO, Hediger ML, Fischer RL. Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol. 1992;45(10):1093–1099
  9. Oberlander T, Warburton W, Misri S, Aghajanian J, Hertzman C. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry. 2006;63:898–906
  10. Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M. Neonatal outcome following maternal antenatal depression and anxiety: a population-based study. Am J Epidemiol. 2004;159:872–881
  11. Suri R, et al. Effects of antenatal depression and antidepressant treatment on gestational age at birth and risk of preterm birth. Am J Psychiatry. 2007;164:1206–1213
  12. Orr S, James S, Blackmore Prince C. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, MD. Am J Epidemiol. 2002;156:797–802
  13. Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev. 2006;29:445–455
  14. DiPietro J, et al. Maternal psychological distress during pregnancy in relation to child development at age two. Child Dev. 2006;77:573–587
  15. Punamaki R. Maternal mental health and medical predictors of infant developmental and health problems from pregnancy to one year: does former infertility matter?. Infant Behavior & Development. 2006;29:230–242
  16. Deave T, Heron J, Evans J, Emond A. The impact of maternal depression in pregnancy on early child development. BJOG. 2008;115:1043–1051
  17. Headley J, Northstone K, Simmons H, Golding J ALSPAC Study Team. Medication use during pregnancy: data from the Avon Longitudinal Study of Parents and Children. Eur J Clin Pharmacol. 2004;60:355–361
  18. Källén BA, Otterblad Olausson P. Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol. 2007;79:301–308
  19. Chambers CD, Johnson KA, Dick LM, Felix RJ. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med. 1996;335:1010–1015
  20. Chun-Fai-Chan B, et al. Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study. Am J Obstet Gynecol. 2005;192:932–936
  21. Einarson A. Pregnancy outcome following gestational exposure to venlafaxine: A multicenter prospective controlled study. Am J Psychiatry. 2001;158
  22. Einarson A, et al. A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry. 2003;48:106–110
  23. Kulin N, et al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors. JAMA. 1998;279(8):609–610
  24. Pastuszak A, et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA. 1993;269(17):2246–2248
  25. Hemels M, Einarson A, Koren G, Lanctot K, Einarson T. Antidepressant use during pregnancy and the rates of spontaneous abortions: a meta-analysis. Ann Pharmacother. 2005;39:803–809
  26. Saraiya M, Berg C, Shulman H, Green C, Atrash H. Estimates of the Annual Number of Clinically Recognized Pregnancies in the United States, 1981-1991. Am J Epidemiol. 1999;149:1025–1029
  27. Simon G, Cunningham M, Davis R. Outcomes of prenatal antidepressant exposure. Am J Psychiatry. 2002;159:2055–2061
  28. Wen S, et al. Selective serotonin reuptake inhibitors and adverse pregnancy outcomes. J Obstet Gynecol. 2006;194:961
  29. Djulus J, et al. Exposure to mirtazapine during pregnancy: a prospective, comparative study of birth outcomes. J Clin Psychiatry. 2006;67:1280–1284
  30. Sivojelezova A, Shuhaiber S, Sarkissian L, Einarson A, Koren G. Citalopram use in pregnancy: prospective comparative evaluation of pregnancy and fetal outcome. J Obstet Gynecol. 2005;193:2004
  31. Malm H, Klaukka T, Neuvonen P. Risks associated with selective serotonin reuptake inhibitors in pregnancy. Obstet Gynecol. 2005;106:1289–1296
  32. Kallen B. Neonate characteristics after maternal use of antidepressants in late pregnancy.. [see comment] Arch Pediatr Adolesc Med. 2004;158:312–316
  33. Oberlander T, Warburton W, Misri S, Aghajanian J, Hertzman C. Effects of timing and duration of gestational exposure to serotonin reuptake inhibitors: population based study. Br J Psychiatry. 2008;192:338–343
  34. Hamilton B, Martin J, Ventura S. Births: preliminary data for 2005. National vital statistics report. In: National Center for Health Statistics. 2007;
  35. Costei A, Kozer E, Ho T, Ito S, Koren G. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med. 2002;156:1129–1132
  36. Altshuler L, et al. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. [see comments] Am J Psychiatry. 1996;153:592–606
  37. Louik C, Lin A, Werler M, Hernandez-Diaz S, Mitchell A. First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med. 2007;356:2675–2683
  38. Alwan S, et al. Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects. N Engl J Med. 2007;356:2684–2692
  39. Kallen B, Otterblad Olausson P. Antidepressant drugs during pregnancy and infant congenital heart defect. Reprod Toxicol. 2006;21:221
  40. Cole J, et al. Bupropion in pregnancy and the prevalence of congenital malformations. Pharmacoepidemiol Drug Saf. 2007;16:474–484
  41. Einarson A, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry. 2008;165:749–752
  42. Oberlander TF. Major congenital malformations following prenatal exposure to serotonin reuptake inhibitors and benzodiazepines using population-based health data. Birth Defects Res B Dev Reprod Toxicol. 2008;83:68–76
  43. Lennestal R, Kallen B. Delivery outcome in relation to maternal use of some recently introduced antidepressants. J Clin Psychopharmacol. 2007;27:607–613
  44. Chambers C, et al. Selective serotonin-reuptake inhibitors and risk of persisitent pulmonary hypertension of the newborn. N Engl J Med. 2006;354:579–587
  45. Oberlander T, et al. Infant serotonin transporter (SLC6A4) promoter genotype is associated with adverse neonatal outcomes after prenatal exposure to serotonin reuptake inhibitor medications. Mol Psychiatry. 2008;13:65–73
  46. Laine K, Heikkinen T, Ekblad U, Kero P. Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations. Arch Gen Psychiatry. 2003;60:720–726
  47. Oberlander T, et al. Pharmacologic factors associated with transient neonatal symptoms following prental psychotropic medication exposure. J Clin Psychiatry. 2004;65:230–237
  48. Zeskind P, Stephens L. Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehavior. Pediatrics. 2004;113:368–375
  49. Källén B, Olausson P. Maternal use of selective serotonin re-uptake inhibitors and persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2008;17:801–806
  50. Greenough A, Khetriwal B. Pulmonary hypertension in the newborn. Paediatr Respir Rev. 2005;6:111–116
  51. Nulman I, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med. 1997;336:258–262
  52. Nulman I, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002;159:1889–1895
  53. Miller L. Use of electroconvulsive therapy during pregnancy. Hosp Commun Psychiatry. 1994;45(5):444–450
  54. Cox J, Holden J. Perinatal psychiatry. Use and misuse of the Edinburgh Postnatal Depression Scale. Glasgow: The Royal College of Psychiatrists; 1994;
  55. Matthey S, Henshaw C, Elliott S, Barnett B. Variability in use of cut-off scores and formats on the Edinburgh Postnatal Depression Scale: implications for clinical and research practice. Arch Women Ment Health. 2006;9:309–315
  56. Spitzer R, Williams J, Kroenke K, Hornyak R, McMurray J. Validity and utility of the Patient Health Questionnaire (PHQ) in assessing 3000 obstetric gynecology patients: The Prime-MD PHQ obstetric gynecology study. Am J Obstet Gynecol. 2000;183(3):759–769
  57. Spinelli M, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry. 2003;160:555–562
  58. Altshuler LL, et al. The Expert Consensus Guideline Series. Treatment of depression in women. Postgrad. Med. 2001;1–107
  59. Wisner K, Gelenberg A, Leonard H, Zarin D, Frank E. Pharmacologic treatment of depression during pregnancy. JAMA. 1999;282:1264–1269
  60. Yonkers K, et al. Management of bipolar disorder during pregnancy and the postpartum period. Am J Psychiatry. 2004;161:608–620
  61. Finer L, Henshaw S. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006;38:90–96
  62. Rush A, et al. Depression in primary care: Vol. 2. Treatment of Major Depression. Clinical Practice Guideline Number. 5th ed.. Rockville, MD: Agency for Health Care Policy and Research; 1993;
  63. Wisner K, Perel J, Wheeler S. Tricyclic dose requirements across pregnancy. Am J Psychiatry. 1993;150(10):1541–1542
  64. Cohen L, et al. Relapse of major depressive during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295:499–507

☆ Dr. Yonkers has received a research grant from Eli Lilly this past year. She has received study drug from Pfizer for a National Institute of Mental Health trial. Dr. Stewart serves on the Advisory Boards of Wyeth and Eli Lilly and Boehringer Ingelheim. Dr. Dell has received research grants from Pfizer has consulted to Bayer Schering Pharma AG and Berlex and is on the Speaker's Bureau for Berlex, GlaxoSmithKline, Pfizer and Wyeth. Dr. Wisner serves on the Speaker's Board of Glaxo Smith Klein. Dr. Oberlander; Dr. Ramin; and Drs. Stotland, Chaudron, and Lockwood have no conflicts to disclose.

☆☆ This article is being published concurrently in the September 2009 issue of Obstetrics & Gynecology.

PII: S0163-8343(09)00061-9

doi: 10.1016/j.genhosppsych.2009.04.003

General Hospital Psychiatry
Volume 31, Issue 5 , Pages 403-413 , September 2009

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