MONDAY, March 5 (HealthDay News) -- Pregnant women taking
certain antidepressants may be more likely to deliver infants with
reduced head growth, a new study suggests.
The researchers also found that although selective serotonin
reuptake inhibitors (SSRIs) such as Paxil and Prozac relieved
depression in these women, they appeared to be associated with a
higher risk of preterm birth.
"Fetal body growth is a marker of fetal health and fetal head growth is a marker for brain development," said lead researcher Hanan El Marroun, a postdoctorate fellow in the department of child and adolescent psychiatry at Sophia Children's Hospital and Erasmus Medical Center in Rotterdam, the Netherlands. "We found prenatal exposure to SSRIs was associated with decreased growth of the head, but not decreased growth of the body."
In mothers with untreated depression, the babies had smaller
growth in both the body and head, the investigators found.
"If the depression is untreated, it affected the whole body; but if the mother used SSRIs, the head growth of the fetus was affected," El Marroun noted. "This may mean that smaller head growth is not explained by depression, but by the SSRIs."
This suggests that imbalance in the brain's serotonin -- a
chemical that helps the brain send signals from one area to another
-- is not good for infants' developing brains, she said. SSRIs
specifically target serotonin.
"We don't know what this means for the long-term development of these children," El Marroun said.
Doctors might be prescribing SSRIs too often, and there may be
alternatives for pregnant women, she suggested. "Sometimes
depression can be treated without medication," El Marroun said.
The report was published in the March 5 online edition of the
Archives of General Psychiatry.
For the study, El Marroun's team studied birth outcomes in
nearly 7,700 pregnant women.
Among these women, 91 percent had no or very mild symptoms of
depression, about 7 percent had symptoms of depression but did not
take SSRIs, and just over 1 percent were depressed and used SSRIs
Women who were depressed but did not take SSRIs tended to have
babies that had smaller bodies and heads, while women who used
SSRIs tended to have infants with smaller heads but not smaller
bodies, the study found.
Children of mothers using SSRIs had less head-circumference
growth than children of depressed mothers not treated with SSRIs,
although these babies also showed a reduced growth of head
Fetal head circumference may be an indicator of brain weight,
and small head size in infants from birth to 4 weeks of age may be
predictive of behavioral problems and psychiatric disorders, the
However, "we must be careful not to infer an association of SSRI
use in pregnancy with future developmental problems," the
researchers stated in their report.
In addition, the investigators found that children of depressed
mothers who did not use SSRIs were born slightly later than usual
(about one day). Children of mothers who used SSRIs were twice as
likely to be born preterm.
This study shows only an association and not a cause-and-effect
relationship between SSRIs, depression and birth outcomes, El
The findings add to the growing literature on the risks
associated with SSRIs and depression, and suggest that the choices
women make about using SSRIs during pregnancy are difficult, said
Michael O'Hara, a professor of psychology at the University of Iowa
in Iowa City.
"One thing is disturbing about the paper," O'Hara said. "It ignores the fact that antidepressant medication is only one approach to the treatment of depression during pregnancy or any other time."
There is evidence that psychological treatments for depression
can be used during pregnancy, or earlier for women who plan their
pregnancies, O'Hara said.
"These psychological treatments allow a woman to avoid antidepressant medication, but at the same time receive very good treatment for their depression," he said.
Although some depressed pregnant women will need
antidepressants, the majority do not require the medication if they
are receiving psychological care, such as interpersonal
psychotherapy or behavioral therapy, O'Hara added.
For more about
depression during pregnancy, visit the U.S. Department of Health and Human Services Office on Women's Health.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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