Information for Providers on Antidepressants During Pregnancy and Breast Feeding - September 2011

This chart is produced by the University of Illinois at Chicago (UIC) Perinatal Mental Health Project as a summary of research on antidepressants in human pregnancy and breastfeeding.

• Pregnancy data: Data summarized here are from controlled studies in human pregnancy. The Food and Drug Administration (FDA) Pregnancy Risk Categories, as found in the Physicians' Desk Reference1, are based on both animal and human studies. No antidepressants are yet specifically FDA-approved for use during pregnancy. All antidepressants cross the placenta, so there are none that are 'Category A' ("no risk"). Medications that are non-teratogenic in animal studies but have never been studied in humans are classified as 'Category B'. Since teratogenicity does not generalize across species, a 'Category B' classification does not imply greater safety in human pregnancy than a 'Category C' or 'D' classification. Several medications have been shifted from 'Category B' to 'Category C' or 'Category D' as their risks became better known.

• Breastfeeding data: Data about antidepressant effects on breastfeeding babies are predominantly from case reports and case series. For medications with no reported side effects, that does not necessarily mean the medication is "safe"; often it means there are few case reports available. Reported percents of maternal dose to breastfeeding babies are weight-adjusted estimates that include the agent and its active metabolite(s).

• Optimal treatment is based on individual patient characteristics and clinical judgment, especially weighing medication risks against risks of untreated illness. Risks of untreated perinatal depression may include preterm birth and other obstetric complications, increased risk of infection and difficult temperament in the infant, impaired parenting, and psychological effects such as impaired cognitive development, emotional and behavioral problems and increased reactivity to stress in children.

Antidepressants as a group may be associated with following risks: 

• Increased risk of preterm birth and lower gestational age at birth, but without adverse effects on birth weight or Apgar scores

• Increased risk of miscarriage, but rates within norms of the general population

• Neonatal side effects, including respiratory distress, excessive crying, changes in sleep and behavioral state, difficulty sleeping, increased or decreased muscle tone, hyperreflexia, seizures, and/or cardiac arrhythmias.

• Most studies have found no increased risk of gestational hypertension. One retrospective study2 found a possible increased risk of gestational hypertension.

• Possible increased risk of persistent pulmonary hypertension in the newborn with exposure later in pregnancy.

• Most studies have found no increased risk of birth defects. One retrospective study3 found a possible increased risk of anencephaly, craniosynostosis, and omphalocele; another4 found an increased risk of anomalies in general, although absolute risks were small.

• Delay in lactation, however the delay was only for 14 hours on average.

• Kaiser Study showed 2-fold increased risk for Autism spectrum disorder with use of SSRI within one year of delivery and 3-fold increased risk with SSRI use in first trimester.

Information for Providers On Antidepressants During Pregnancy & Breast Feeding - September 2011