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Antidepressants during pregnancy won't lead to stillbirth, infant death, study says

Antidepressants won't increase an expecting mother's risk for stillbirth or having a baby that dies during infancy, a new study shows.

Swedish researchers studied 30,000 women who had filled a prescription for a selective serotonin reuptake inhibitor (SSRI), a commonly-prescribed medication that includes drugs like Prozac, Zoloft, Paxil and Lexapro.

Antidepressants are a primary treatment for depression, but in the context of pregnancy, are often subjects of confusion for expecting families because of medical studies that find varying conclusions.

The new study's authors, led by Dr. Olof Stephansson, a researcher at Karolinska Institutet in Stockholm, Sweden, estimate depression during pregnancy affects between 7 and 19 percent of expecting moms in ecumenically developed countries.

Some earlier studies have suggested a low risk of limb deformities or rare lung and heart problems in newborns from taking certain classes of antidepressants, notes The Mayo Clinic. Other studies have found depression can be harmful to a newborn, so the benefits of taking antidepressants outweigh any low risks.

"However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown," wrote the authors.

The new study involved women who gave single births from Nordic countries from 1996 through 2007, a total pool of more than 1.6 million births. Looking at the raw numbers, the researchers saw pregnant women prescribed SSRI antidepressants had slightly higher rates of stillbirth -- 4.62 per 1,000 pregnancies, versus 3.69 per 1,000 births in general population -- and higher rates of infant death  (2.54 vs. 2.21 deaths per 1,000 pregnancies). However when using analysis models that accounted for other risks that can potentially lead to stillbirth or infant death, the researchers found no statistical risk increases.

"The increased rates of stillbirth and postneonatal mortality among infants exposed to an SSRI during pregnancy were explained by the severity of the underlying maternal psychiatric disease and unfavorable distribution of maternal characteristics such as cigarette smoking and advanced maternal age," they wrote.

The research was published Jan. 1 in the Journal of the American Medical Association (JAMA).

Dr. Rebecca Starck, chair of regional obstetrics and gynecology at the Cleveland Clinic who was not involved in this study, told the findings were nothing new for her, since stillbirth and infant death have not traditionally been considered risks associated pregnant women taking antidepressants.

Often, she said, these studies are observational, meaning researchers compare one group to another. Even then, the suggested risks found are often very low.

"What I tell my patients is that much of the data is mixed, meaning a direct cause and effect relationship in my mind is not clear," Starck said.

With all the uncertainty about potential risks, what's an expecting family to do?

Starck said if women on antidepressants are considering getting pregnant, they should speak with their doctor beforehand. The doctor should review mental health history, she said, because some women have varying circumstances that affect their mood, and may be able to get taken off of medication and treated successfully with psychotherapy and counseling. Those women are recommended to continue therapy throughout the pregnancy, and need have their mental health monitored by a doctor.

On the other hand, having depression can be risky for moms and babies, leading to preterm labor, premature births and other adjustment problems following the pregnancy. Starck said doctors may see if there is an opportunity to put a pregnant woman who needs antidepressants on a lower dose of the drug.

"Having said that, we don't want to undertreat and put them at risk," she added.

The bottom line? Discuss the risks and benefits with your doctor.

"We don't know for certain," all the risks from taking antidepressants during pregnancy, Starck said, "But we also have to balance that with mom's well-being."

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