New report offers recommendations for treating depression in pregnant women

WASHINGTON Pregnant women with depression face complicated treatment decisions because of the risks associated with both untreated depression and the use of antidepressants, according to a new report from The American College of Obstetricians and Gynecologists and the American Psychiatric Association on Friday.

Based on an extensive review of existing research, ACOG and APA offer recommendations for the treatment of women with depression during pregnancy. The report, “The Management of Depression During Pregnancy: A Report from the American Psychiatric Association and The American College of Obstetricians and Gynecologists,” is published in Obstetrics & Gynecology (September 2009) and General Hospital Psychiatry (September/October 2009).

Depression is common during pregnancy — between 14% and 23% of pregnant women will experience depressive symptoms while pregnant. In 2003, approximately 13% of women took an antidepressant at some time during their pregnancy.

“Depression in pregnant women often goes unrecognized and untreated in part because of concerns about the safety of treating women during pregnancy,” stated lead author Kimberly Ann Yonkers, Yale University associate professor of psychiatry and obstetrics, gynecology and reproductive sciences. “It is our hope that this will be a resource to clinicians who care for pregnant women who have or are at risk of developing major depressive disorder.”

Both depression symptoms and the use of antidepressant medications during pregnancy have been associated with negative consequences for the newborn. Infants born to women with depression have increased risk for irritability, less activity and attentiveness, and fewer facial expressions compared with those born to mothers without depression. Depression and its symptoms are also associated with fetal growth change and shorter gestation periods. And while available research still leaves some questions unanswered, some studies have linked fetal malformations, cardiac defects, pulmonary hypertension, and reduced birth weight to antidepressant use during pregnancy.

Identifying depression in pregnant women can be difficult because its symptoms mimic those associated with pregnancy, such as changes in mood, energy level, appetite, and cognition. Depressed women are more likely to have poor prenatal care and such pregnancy complications as nausea, vomiting, and preeclampsia, and to use drugs, alcohol, and nicotine.

“Ob-gyns are the front-line physicians for most pregnant women and may be the first to make a diagnosis of depression or to observe depressive symptoms getting worse. In the past, reproductive health practitioners have felt ill equipped to treat these patients because of the lack of available guidance concerning the management of depressed women during pregnancy,” commented ACOG president Gerald Joseph. “This joint report bridges the gap by summarizing current research on various depression treatment methods and can assist clinicians in decision-making. Many people — physicians and women alike — will be glad to know that their choices go beyond ‘medication or nothing.’”