Risk of psychopathology in the offspringAuthors:Donna Stewart, CM, MD, FRCPCSimone Vigod, MD, MSc, FRCPCSection Editors:Peter P Roy-Byrne, MDJoseph A Garcia-Prats, MDDeputy Editor:David Solomon, MD
INTRODUCTIONDepressive disorders and anxiety disorders occur in approximately 10 to 15 percent of pregnant women and can have short- and long-term deleterious effects upon the mother, child, and family [1-4]. Although patients with mild to moderate illness may respond to psychotherapy, patients with severe (eg, suicidality or psychosis), chronic, or recurrent syndromes often require pharmacotherapy.
The decision to prescribe antidepressants for pregnant patients requires clinicians to weigh the negative impact of untreated mood and anxiety disorders against the adverse effects of antidepressants. Although the risks to the offspring from antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) appear to be small to nonexistent, the potential risks are uncertain due to the lack of high quality data on the impact of these drugs. The complexity of managing pregnant women with mood and anxiety disorders requires coordinated efforts among psychiatrists, primary care clinicians, obstetricians, and pediatricians.
Maternal use of SSRIs and SNRIs during pregnancy is estimated at roughly 8 percent . SSRIs and SNRIs are first- and second-line medications for depressive and anxiety disorders, as well as other disorders such as obsessive-compulsive disorder and posttraumatic stress disorder. In addition, these antidepressants are often combined with second-generation antipsychotics for treating bipolar major depression in pregnant women.
When studying the long-term effects of antenatal antidepressants, it is difficult to disentangle medication effects from other factors, such as pre-existing and ongoing maternal psychiatric illness. Women with psychiatric symptoms in pregnancy are at high risk for postpartum depression and anxiety, and thus for impaired mother-infant interactions that are associated with emotional and behavioral dysfunction in the offspring . Maternal depression and anxiety can be chronic and recurrent , so the impact upon children can extend beyond the immediate postnatal phase. In addition, the evidence suggests that children of depressed mothers are more likely to exhibit psychiatric symptoms and disorders (eg, anxiety disorders, depressive disorders, attention deficit hyperactivity disorder, oppositional defiant disorder, and other behavioral disturbances) compared with children of mothers with remitted depression [7-10].
This topic reviews the association between antenatal exposure to SSRIs and SNRIs and the risk of psychopathology in the offspring. Antenatal exposure to SSRIs and SNRIs and neonatal outcomes, as well as the risk of abnormalities in growth, motor skills, and cognition, are discussed separately. The antenatal use of antidepressants and risk of teratogenicity and adverse pregnancy outcomes are also discussed separately, as are the clinical features and choice of treatment for antenatal depression, and the risks of exposure to antenatal depression:To continue reading this article, you must log in with your personal, hospital, or group practice subscription.
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