Evidence-Based Reviews

Awareness and management of obstetrical complications of depression

Current Psychiatry. 2015 December;14(12):39-44

References

1. American College of Obstetricians and Gynecologists. Committee on Obstetric Practice. Committee opinion no. 630. 2015;125:1268-1271.
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Likewise, it is difficult to clarify the extent to which antidepressants contribute to infant growth restriction, if at all. Two recent meta-analyses concluded that exposure to antidepressants is associated with a statistically significant risk of LBW.^42,43 However, increased severity of depressive symptoms generally is associated with exposure to antidepressants during pregnancy, and a randomized controlled trial is, again, impossible to conduct for ethical reasons.

Whereas a plausible biological mechanism associating IUGR, SGA, and LBW with depression exists, the same cannot be said for antidepressants. In one study, exposure to maternal depression altered the expression of certain placental genes but exposure to SSRIs did not cause further changes. This suggests that, on a cellular level, placental function might differ in depressed women.⁴⁴ Although antidepressants do cross the placenta, it remains to be seen whether fetal growth is impacted as a result. One study found decreased fetal head circumference in infants who had been exposed to antidepressants during pregnancy, but no increased risk for having a SGA or LWB infant.⁴⁵

Obstetrical management and mental health implications
Treated or not, women who suffer depression are a high-risk group when it comes to preterm birth and a host of other pregnancy comorbidities. Women with serious complications of pregnancy often are hospitalized for observation, and can undergo a prolonged stay when close proximity to medical services or a surgical suite is required.

For example, hospitalization until delivery is the standard of care for women who have preterm premature rupture of membranes or preeclampsia before 34 weeks’ gestation. Prolonged inpatient admissions and associated restriction of activity is profoundly deleterious on mood, with depression and anxiety significantly correlated with length of stay.^46,47 Given the associations between depression and preterm birth, it might be reasonable to consider screening antenatal inpatients at risk of preterm birth for depression on a regular basis, so that treatment can be initiated if needed.

Depression during pregnancy is relatively common; an estimated 12.7% of pregnant women are affected at some time between conception and birth.⁴⁸ Not only does depression appear to have deleterious effects on pregnancy outcomes, it also plays a pivotal role in the qualitative experience of pregnancy for the mother.

Bottom Line
Awareness of obstetrical complications associated with depression in pregnancy is important for the entire care team, including the psychiatrist and obstetrician. Depression not only appears to have deleterious effects on pregnancy outcomes, it also plays a pivotal role in the qualitative experience of pregnancy for the mother. Antidepressant use generally is fraught with concerns over teratogenicity and adverse fetal outcomes.

Related Resources
• Freeman MP. Some SSRIs are better than others for pregnant women (audio interview). Current Psychiatry. 2014;13(7). http://www.currentpsychiatry.com/specialty-focus/practice-trends/article/some-ssris-are-better-thanothers-for-pregnant-women/e3adb4704e25492f3e15331fc1cc058d.html.
• Freeman MP, Joffe H, Cohen LS. Postpartum depression: Help patients find the right treatment. Current Psychiatry. 2012;11(11):14-16,19-21.

Disclosures
Dr. Habecker reports no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

Dr. Freeman is a member of the advisory board of JDS Therapeutics, Sunovion Pharmaceuticals, Inc., and Takeda Pharmaceutical Co. She receives research grant support from Takeda Pharmaceutical Co.

Awareness and management of obstetrical complications of depression

References

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