{"product_id":"antidepressants-during-pregnancy-weighing-the-risks-of-medication-vs-untreated-depression","title":"Antidepressants During Pregnancy: Weighing the Risks of Medication vs. Untreated Depression","description":"\u003cp\u003eWomen who take antidepressants during pregnancy face a difficult decision: is it safer to continue medication or to risk untreated depression? Recent research, including a new study highlighted in this editorial, suggests that antidepressant exposure may have only minor effects on birth outcomes, while untreated maternal depression poses its own significant risks to both mother and child. This article explains what researchers currently know about the safety of antidepressants during pregnancy, the small differences observed in birth outcomes, and why the debate is about weighing risks on both sides.\u003c\/p\u003e\n\n\u003ch1\u003eAntidepressants During Pregnancy: Weighing the Risks of Medication vs. Untreated Depression\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n  \u003cli\u003e\u003ca href=\"#introduction\"\u003eIntroduction: The Big Question\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#guidelines\"\u003eWhat Medical Guidelines Say\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#birth-defects\"\u003eBirth Defects: Understanding the Numbers\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#meta-analysis\"\u003eA Closer Look: The Author's Systematic Review and Meta-Analysis\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#development\"\u003eChild Development: What Long-Term Studies Show\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#nulman\"\u003eThe New Study: Nulman and Colleagues' Findings\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#motherisk\"\u003eEarlier Evidence from the Motherisk Program\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#clinical\"\u003eClinical Implications: What This Means for Doctors and Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#limitations\"\u003eStudy Limitations\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eAntidepressant use during pregnancy has not been shown to raise birth defect risk above the 2%–3% general population baseline, except paroxetine.\u003c\/li\u003e\n\u003cli\u003eA meta-analysis found exposed infants had gestational age about 3 days shorter and birth weight 75 grams lower, but within normal ranges.\u003c\/li\u003e\n\u003cli\u003eLong-term studies found no significant negative impact on child development from prenatal antidepressant exposure.\u003c\/li\u003e\n\u003cli\u003eUntreated depression during pregnancy is linked to fetal, cognitive, and behavioral problems in children, plus higher postpartum depression risk.\u003c\/li\u003e\n\u003cli\u003eDecision-making requires individualized weighing of medication risks versus untreated depression risks, with informed consent and doctor discussion.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"introduction\"\u003eIntroduction: The Big Question\u003c\/h2\u003e\n\n\u003cp\u003eFor millions of women who take antidepressants, discovering they are pregnant raises an immediate and deeply personal question: Should I keep taking this medication, or is it safer for my baby if I stop?\u003c\/p\u003e\n\n\u003cp\u003eThe answer is not simple. As Dr. Meir Steiner of McMaster University in Hamilton, Ontario, explains in this editorial, the question of whether treating maternal depression during pregnancy is better or worse for the child than leaving the depression untreated remains \u003cstrong\u003elargely unanswered\u003c\/strong\u003e.\u003c\/p\u003e\n\n\u003cp\u003eSteiner emphasizes that this is not just a theoretical debate. Depression, anxiety, and stress during pregnancy—especially in the early stages—are known to have harmful effects on the developing baby. Yet many women and their doctors are also concerned about the potential risks of antidepressant exposure. This creates a genuine dilemma that requires careful, individualized decision-making.\u003c\/p\u003e\n\n\u003ch2 id=\"guidelines\"\u003eWhat Medical Guidelines Say\u003c\/h2\u003e\n\n\u003cp\u003eOver the past five years, several major medical organizations have published guidelines addressing this very question. These include:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe American Psychiatric Association and the American College of Obstetricians and Gynecologists (2009)\u003c\/li\u003e\n  \u003cli\u003eGreat Britain's National Institute for Health and Clinical Excellence (NICE, 2007)\u003c\/li\u003e\n  \u003cli\u003eThe Scottish Intercollegiate Guidelines Network (SIGN, 2012)\u003c\/li\u003e\n  \u003cli\u003eThe Black Dog Institute of Australia (2012)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eAll of these guidelines reach a similar conclusion. They end with a \u003cstrong\u003ecautionary statement\u003c\/strong\u003e that the decision to use medication during pregnancy must carefully take into account any possible risk associated with using antidepressants at this time.\u003c\/p\u003e\n\n\u003cp\u003eThat may sound cautious, but it reflects a genuine uncertainty in the medical community. The evidence is not yet strong enough to give a definitive answer in either direction.\u003c\/p\u003e\n\n\u003ch2 id=\"birth-defects\"\u003eBirth Defects: Understanding the Numbers\u003c\/h2\u003e\n\n\u003cp\u003eMuch of the existing research on antidepressants during pregnancy has focused on two concerns: the risk of birth defects (malformations) and the risk of a temporary withdrawal-like condition in newborns called \u003cstrong\u003eneonatal discontinuation syndrome\u003c\/strong\u003e (also known as neonatal withdrawal or adaptation syndrome).\u003c\/p\u003e\n\n\u003cp\u003eSteiner points out a key limitation in this research. Much of the monitoring is based on \u003cstrong\u003eretrospective case-control surveillance\u003c\/strong\u003e, a method in which researchers look back at past cases. This approach has well-known limitations, including difficulty in accurately recalling medication use and potential biases in which cases get reported.\u003c\/p\u003e\n\n\u003cp\u003eSo what do the numbers actually say? According to the \u003cstrong\u003eMetropolitan Atlanta Congenital Defects Program\u003c\/strong\u003e, the risk of major structural or genetic birth defects in the United States is approximately \u003cstrong\u003e3% of all births\u003c\/strong\u003e. This is the baseline risk that every pregnancy carries, regardless of medication use.\u003c\/p\u003e\n\n\u003cp\u003eThe encouraging news, Steiner reports, is that:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThere is \u003cstrong\u003eno report\u003c\/strong\u003e suggesting that antidepressant use during pregnancy increases the risk of birth defects above the general population risk of \u003cstrong\u003e2%–3%\u003c\/strong\u003e\n\u003c\/li\u003e\n  \u003cli\u003eThere is \u003cstrong\u003eno evidence\u003c\/strong\u003e that antidepressants cause organ-specific defects\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThere is, however, one important exception. Some reports suggest that the antidepressant \u003cstrong\u003eparoxetine\u003c\/strong\u003e (brand name Paxil) used early in pregnancy is associated with an increased risk of \u003cstrong\u003eatrium septum defects\u003c\/strong\u003e—a type of hole in the wall between the upper chambers of the heart.\u003c\/p\u003e\n\n\u003ch2 id=\"meta-analysis\"\u003eA Closer Look: The Author's Systematic Review and Meta-Analysis\u003c\/h2\u003e\n\n\u003cp\u003eSteiner and his colleagues recently completed a \u003cstrong\u003elarge systematic review and meta-analysis\u003c\/strong\u003e—a type of study that combines and analyzes the results of many previous studies—looking at pregnancy and delivery outcomes after antidepressant exposure. This work was authored by Ross et al. and published in the Archives of General Psychiatry.\u003c\/p\u003e\n\n\u003cp\u003eSpecifically, the review focused on three outcomes among infants exposed to antidepressants in the womb:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003eGestational age (how long the baby was in the womb)\u003c\/li\u003e\n  \u003cli\u003eBirth weight\u003c\/li\u003e\n  \u003cli\u003eAPGAR scores (a quick assessment of a newborn's health, measured at 1 and 5 minutes after birth)\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eThe results showed statistically significant associations for all three outcomes. But here is where it is important to interpret the numbers carefully. The differences were \u003cstrong\u003eremarkably small\u003c\/strong\u003e:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eGestational age: approximately \u003cstrong\u003e3 days shorter\u003c\/strong\u003e in the exposed group\u003c\/li\u003e\n  \u003cli\u003eBirth weight: \u003cstrong\u003e75 grams lower\u003c\/strong\u003e (about 2.6 ounces, or roughly the weight of a small apple)\u003c\/li\u003e\n  \u003cli\u003eAPGAR scores at 1 and 5 minutes: a difference of \u003cstrong\u003eless than half a point\u003c\/strong\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eCritically, the values in the exposed group \u003cstrong\u003etypically fell within the normal range\u003c\/strong\u003e. In other words, while the differences were statistically measurable, they were not large enough to be considered clinically significant in a way that would alarm parents or pediatricians.\u003c\/p\u003e\n\n\u003ch2 id=\"development\"\u003eChild Development: What Long-Term Studies Show\u003c\/h2\u003e\n\n\u003cp\u003eFewer studies have looked at the longer-term picture: what happens to children's development after exposure to antidepressants before birth. The handful of studies that do exist have examined cognitive and behavioral functioning in preschoolers, as well as long-term follow-up into adolescence and adulthood.\u003c\/p\u003e\n\n\u003cp\u003eAccording to Steiner, \u003cstrong\u003enone of these studies suggests any significant negative impact\u003c\/strong\u003e from prenatal antidepressant exposure. Two major studies support this view:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe \u003cstrong\u003eDanish National Birth Cohort\u003c\/strong\u003e (Pedersen et al., 2010) found no delays in normal milestone development at 6 and 19 months of age\u003c\/li\u003e\n  \u003cli\u003eThe \u003cstrong\u003eNorwegian Mother and Child Cohort Study\u003c\/strong\u003e (Nordeng et al., 2012) reported similarly reassuring findings\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eBut here is the other side of the coin. Steiner stresses that there is \u003cstrong\u003eample evidence\u003c\/strong\u003e that anxiety, depression, and particularly stress during pregnancy—especially early in gestation—can have adverse effects on:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eFetal maturation\u003c\/li\u003e\n  \u003cli\u003eCognitive performance during infancy\u003c\/li\u003e\n  \u003cli\u003eLearning and memory in 6-to-8-year-old children\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThis creates a paradox: the very condition being treated can itself cause harm if left untreated.\u003c\/p\u003e\n\n\u003ch2 id=\"nulman\"\u003eThe New Study: Nulman and Colleagues' Findings\u003c\/h2\u003e\n\n\u003cp\u003eIn this issue of the American Journal of Psychiatry, Nulman and colleagues, from the Motherisk Program at the Hospital for Sick Children in Toronto, present new data on the long-term neurodevelopment of children exposed to two types of antidepressants—\u003cstrong\u003evenlafaxine\u003c\/strong\u003e (a serotonin-norepinephrine reuptake inhibitor, or SNRI) and \u003cstrong\u003eselective serotonin reuptake inhibitors\u003c\/strong\u003e (SSRIs)—compared to children of mothers with untreated depression.\u003c\/p\u003e\n\n\u003cp\u003eThe findings are striking:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe results \u003cstrong\u003efailed to show any effect\u003c\/strong\u003e of antidepressant medication on children's intellectual or behavioral outcomes\u003c\/li\u003e\n  \u003cli\u003eInstead, \u003cstrong\u003euntreated depression\u003c\/strong\u003e was associated with a higher risk for the mother developing postpartum depression\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003ePrenatal and childhood exposure to maternal depression\u003c\/strong\u003e was associated with behavioral problems in the offspring and may increase the risk for long-term psychopathology (mental health disorders)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIn plain terms: the depression itself appears to be the greater threat to a child's long-term mental health, not the medication used to treat it.\u003c\/p\u003e\n\n\u003ch2 id=\"motherisk\"\u003eEarlier Evidence from the Motherisk Program\u003c\/h2\u003e\n\n\u003cp\u003eThis is not the first time this research group has reported such findings. Ten years earlier, in 2002, the same Motherisk group published a prospective, controlled study with remarkably similar results.\u003c\/p\u003e\n\n\u003cp\u003eIn that earlier study, Nulman and colleagues found that exposure to \u003cstrong\u003etricyclic antidepressants\u003c\/strong\u003e or \u003cstrong\u003efluoxetine\u003c\/strong\u003e (brand name Prozac) throughout gestation was:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eNot associated with poor cognition\u003c\/li\u003e\n  \u003cli\u003eNot associated with delays in language development\u003c\/li\u003e\n  \u003cli\u003eNot associated with temperament problems in preschool and early-school children\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eMeanwhile, \u003cstrong\u003ematernal depression\u003c\/strong\u003e was associated with lower cognitive and language achievement in the children. The consistency of these findings over a decade, covering both older and newer antidepressants, provides growing reassurance about medication safety relative to the risks of untreated illness.\u003c\/p\u003e\n\n\u003ch2 id=\"clinical\"\u003eClinical Implications: What This Means for Doctors and Patients\u003c\/h2\u003e\n\n\u003cp\u003eSo does this mean every pregnant woman with depression should be prescribed an antidepressant? Not exactly. Steiner offers several important caveats.\u003c\/p\u003e\n\n\u003cp\u003eRegardless of the encouraging evidence, health care providers should keep in mind that the \u003cstrong\u003eindication for prescribing antidepressants during pregnancy must be compelling\u003c\/strong\u003e. This means:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003eIt is crucial to establish a proper psychiatric diagnosis (formally called an Axis I diagnosis) before starting or continuing treatment\u003c\/li\u003e\n  \u003cli\u003eIt is important to assess the \u003cstrong\u003edegree of distress\u003c\/strong\u003e and the \u003cstrong\u003eburden of illness\u003c\/strong\u003e the pregnant woman is actually experiencing\u003c\/li\u003e\n  \u003cli\u003eIt is paramount to have a \u003cstrong\u003efrank discussion\u003c\/strong\u003e with the patient—and whenever possible, with her partner present—about the pros and cons of using antidepressants during pregnancy, based on the most recent available evidence\u003c\/li\u003e\n  \u003cli\u003eThe clinician must obtain the patient's, or the couple's, informed consent\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eIn other words, antidepressants are not to be prescribed casually during pregnancy, but they should not be withheld when genuinely needed. The decision requires individualized, shared decision-making.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eStudy Limitations\u003c\/h2\u003e\n\n\u003cp\u003eThis editorial itself is not a clinical trial, and it is important to understand its limitations:\u003c\/p\u003e\n\n\u003cul\u003e\n  \u003cli\u003eThe conclusions draw on the existing body of research, much of which relies on observational data rather than randomized controlled trials\u003c\/li\u003e\n  \u003cli\u003eRetrospective case-control surveillance, commonly used to monitor birth defects, has inherent limitations, including recall bias and reporting bias\u003c\/li\u003e\n  \u003cli\u003eThe author notes that the question of whether antidepressant treatment is better or worse than untreated maternal depression is \u003cstrong\u003estill mostly unanswered\u003c\/strong\u003e, meaning that even the reassuring findings must be considered within the context of ongoing scientific uncertainty\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe truth is that randomized controlled trials of antidepressants during pregnancy would raise significant ethical concerns, so researchers must rely on large observational cohorts and meta-analyses to piece together the picture.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eIf you are pregnant or planning to become pregnant and are taking an antidepressant—or if you are experiencing symptoms of depression during pregnancy—here is what the current evidence suggests:\u003c\/p\u003e\n\n\u003col\u003e\n  \u003cli\u003e\n\u003cstrong\u003eDo not stop or change your medication without speaking to your doctor first.\u003c\/strong\u003e Abruptly stopping can trigger withdrawal symptoms and a relapse of depression, which carries its own risks.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eHave an informed conversation with your health care provider.\u003c\/strong\u003e Discuss the specific antidepressant you are taking, the dose, and your personal history of depression. Paroxetine (Paxil) may carry a slightly higher risk of a specific heart defect, so alternative options may be worth discussing.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eKnow the baseline risk.\u003c\/strong\u003e The general population risk of major birth defects is about 2%–3%, and studies to date have not shown antidepressants to raise that risk overall.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eUnderstand that untreated depression matters.\u003c\/strong\u003e Depression, anxiety, and stress during pregnancy are linked to problems in fetal development, cognitive performance in infancy, and learning and memory issues in childhood.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eTake untreated depression seriously.\u003c\/strong\u003e Untreated depression is associated with a higher risk of postpartum depression, and children exposed to maternal depression are at higher risk for behavioral problems and long-term mental health difficulties.\u003c\/li\u003e\n  \u003cli\u003e\n\u003cstrong\u003eConsider the whole picture.\u003c\/strong\u003e The decision is not simply \"medication vs. no medication.\" It is about weighing the risks of treatment against the risks of untreated illness—for both you and your child.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eEvery pregnancy is unique, and so is every woman's mental health history. The best decision will be one made collaboratively between you and a trusted health care provider, with your partner involved whenever possible.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eShould I stop taking my antidepressant if I find out I am pregnant?\u003c\/h3\u003e\n\u003cp\u003eDo not stop or change your medication without speaking to your doctor first. Abruptly stopping can trigger withdrawal symptoms and a relapse of depression, which carries its own risks. Have an informed conversation with your health care provider about the specific antidepressant, dose, and your personal history.\u003c\/p\u003e\n\u003ch3\u003eDo antidepressants during pregnancy increase the risk of birth defects?\u003c\/h3\u003e\n\u003cp\u003eStudies to date have not shown antidepressant use to raise the overall risk of major birth defects above the general population risk of about 2%–3%. There is one exception: some reports link paroxetine (Paxil) used early in pregnancy with a slightly higher risk of a specific heart defect. Discuss alternatives with your doctor.\u003c\/p\u003e\n\u003ch3\u003eWhat are the risks of untreated depression during pregnancy?\u003c\/h3\u003e\n\u003cp\u003eUntreated depression, anxiety, and stress during pregnancy can harm fetal development, cognitive performance in infancy, and learning and memory in childhood. Untreated depression also increases the mother's risk of postpartum depression and children's risk of behavioral problems and long-term mental health difficulties.\u003c\/p\u003e\n\u003ch3\u003eDo antidepressants affect the baby's birth weight or gestational age?\u003c\/h3\u003e\n\u003cp\u003eA systematic review and meta-analysis found small differences: gestational age about 3 days shorter and birth weight 75 grams lower in exposed infants. These values typically fell within the normal range, so the differences were statistically measurable but not clinically significant enough to alarm parents or pediatricians.\u003c\/p\u003e\n\u003ch3\u003eDo antidepressants affect a child's long-term development?\u003c\/h3\u003e\n\u003cp\u003eLong-term studies, including the Danish National Birth Cohort and the Norwegian Mother and Child Cohort Study, found no significant negative impact on development. A new study by Nulman and colleagues found no effect on intellectual or behavioral outcomes from medication, but untreated maternal depression was linked to behavioral problems.\u003c\/p\u003e\n\u003ch3\u003eIs it better to take antidepressants or leave depression untreated during pregnancy?\u003c\/h3\u003e\n\u003cp\u003eThe editorial states this question is largely unanswered, but evidence suggests the depression itself appears to be the greater threat to a child's long-term mental health than the medication. The decision requires weighing risks on both sides and making an individualized choice with your doctor and partner.\u003c\/p\u003e\n\u003ch3\u003eHow should I decide whether to take antidepressants during pregnancy?\u003c\/h3\u003e\n\u003cp\u003eDiscuss with your doctor: establish a proper psychiatric diagnosis, assess the degree of distress, and have a frank discussion about pros and cons based on recent evidence. Involve your partner if possible, and give informed consent. Antidepressants should not be prescribed casually, but not withheld when genuinely needed.\u003c\/p\u003e\n\u003ch3\u003eShould I get a second opinion about continuing antidepressants during pregnancy?\u003c\/h3\u003e\n\u003cp\u003eA pregnant woman taking antidepressants—or considering them for depression—should seek a second opinion if she or her doctor is unsure whether to continue, stop, or switch medication. The decision must balance small, mostly normal-range differences in birth outcomes (about 3 days shorter gestation, 75 grams lower birth weight) against real risks of untreated depression, including higher postpartum depression rates and child behavioral problems. Because paroxetine may carry a slightly higher risk of a specific heart defect, a second opinion can help explore alternatives. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003eThis patient-friendly article is based on the following peer-reviewed editorial:\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eTitle:\u003c\/strong\u003e \"Prenatal Exposure to Antidepressants: How Safe Are They?\"\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication:\u003c\/strong\u003e American Journal of Psychiatry, 169(11):1130–1132, November 2012\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDOI:\u003c\/strong\u003e 10.1176\/appi.ajp.2012.12081126\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eKey studies referenced in this editorial:\u003c\/strong\u003e\u003c\/p\u003e\n\u003cul\u003e\n  \u003cli\u003eYonkers KA, et al. (2009). The management of depression during pregnancy: APA\/ACOG report. General Hospital Psychiatry, 31:403–413.\u003c\/li\u003e\n  \u003cli\u003eNICE (2007). Antenatal and Postnatal Mental Health: The NICE Guideline.\u003c\/li\u003e\n  \u003cli\u003eSIGN (2012). Management of Perinatal Mood Disorders.\u003c\/li\u003e\n  \u003cli\u003eBlack Dog Institute (2012). Safety of Antidepressants in Pregnancy and Breastfeeding.\u003c\/li\u003e\n  \u003cli\u003eCDC (2008). Update on overall prevalence of major birth defects—Atlanta, Georgia, 1978–2005. MMWR, 57:1–5.\u003c\/li\u003e\n  \u003cli\u003eBérard A, et al. (2007). First trimester exposure to paroxetine and risk of cardiac malformations. Birth Defects Research, 80:18–27.\u003c\/li\u003e\n  \u003cli\u003eBakker MK, et al. (2010). First-trimester use of paroxetine and congenital heart defects. Birth Defects Research, 88:94–100.\u003c\/li\u003e\n  \u003cli\u003eEl Marroun H, et al. (2012). Maternal SSRI use, fetal growth, and adverse birth outcomes. Archives of General Psychiatry, 69:706–714.\u003c\/li\u003e\n  \u003cli\u003eOcchiogrosso M, et al. (2012). Persistent pulmonary hypertension of the newborn and SSRIs. American Journal of Psychiatry, 169:134–140.\u003c\/li\u003e\n  \u003cli\u003eRoss LE, et al. (in press). Effects of prenatal antidepressant treatment on pregnancy and delivery outcomes: a systematic review and meta-analysis. Archives of General Psychiatry.\u003c\/li\u003e\n  \u003cli\u003ePedersen LH, et al. (2010). Fetal exposure to antidepressants and normal milestone development at 6 and 19 months. Pediatrics, 125:e600–e608.\u003c\/li\u003e\n  \u003cli\u003eNordeng H, et al. (2012). Pregnancy outcome after exposure to antidepressants. Journal of Clinical Psychopharmacology, 32:186–194.\u003c\/li\u003e\n  \u003cli\u003eSandman CA, et al. (2012). Exposure to prenatal psychobiological stress. Neuroendocrinology, 95:8–21.\u003c\/li\u003e\n  \u003cli\u003eBuss C, et al. (2011). Maternal pregnancy-specific anxiety and child executive function at 6–9 years. Stress, 14:665–676.\u003c\/li\u003e\n  \u003cli\u003eNulman I, et al. (2012). Neurodevelopment of children following prenatal exposure to venlafaxine, SSRIs, or untreated maternal depression. American Journal of Psychiatry, 169:1165–1174.\u003c\/li\u003e\n  \u003cli\u003eNulman I, et al. (2002). Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life. American Journal of Psychiatry, 159:1889–1895.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003e\u003cstrong\u003eConflict of interest disclosure:\u003c\/strong\u003e Dr. Steiner has served as a consultant for AstraZeneca, Azevan, Bayer Schering, Lundbeck, Servier, and Wyeth; has received grants or research support from AstraZeneca, the Canadian Institutes of Health Research, GlaxoSmithKline, Lundbeck, Pfizer, and Wyeth; and has received honoraria from AstraZeneca, Azevan, Ortho-McNeil, and the Society for Women's Health Research.\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research and is intended for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47471119138972,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/ar\/products\/antidepressants-during-pregnancy-weighing-the-risks-of-medication-vs-untreated-depression","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}