Antidepressants Increase Risk of Preterm Delivery

April 3, 2014

Antidepressant use in pregnancy increases the risk of preterm birth. However, untreated depression is serious, and the needs of the mother must come first.

Taking antidepressants during pregnancy increases the chances of preterm birth, a meta-analysis of 41 studies suggested.

The authors reported that the risk of preterm birth is increased in women treated with antidepressants during pregnancy, with pooled odds ratio estimates ranging between 1.16 (95% CI, 0.92–1.45) and 1.96 (95% CI, 1.62–2.38). 

Pertinent Points

- Taking antidepressants during pregnancy
is associated with increased rates of preterm births.

- Clinicians should weigh the treatment options for depression during pregnancy, given this information. There are circumstances when using antidepressants during pregnancy is appropriate, however.

The finding, reported online in the journal PLOS ONE, reinforces the advice that antidepressants should be avoided during pregnancy if there are therapeutic alternatives to the woman’s mental health needs, the researchers concluded.

Scientific evidence is increasingly pointing to the association between preterm birth and antidepressant use in pregnancy, said senior author Adam Urato, MD, a Maternal-Fetal Medicine specialist at Tufts Medical Center and MetroWest Medical Center. "The complication of preterm birth did not appear to be due to the maternal depression, but rather it appears likely to be a medication effect," he said in a news release.

With the rate of antidepressant use during pregnancy having increased four-fold, the authors noted the importance of understanding the implications of the medicine on fetal outcomes. Still, they cautioned that treating depression during pregnancy is complex and that many factors, including the mother’s health, must be considered. 

"Pregnant women and their providers need to weigh many issues," Urato said. "It is crucial, though, that the public gets accurate information on this topic."

"Pregnant women with depression need proper treatment, and our results should not be seen as an argument to ignore depression in these patients," said lead author Krista Huybrechts, PhD, MS, from the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women's Hospital and Harvard Medical School, in a news release. "These drugs may be necessary in some pregnant women with severe depression in whom other approaches are inadequate. However, for many others, nondrug treatments, such as psychotherapy, will help, and aren't associated with complications like preterm birth."