Depression Poses Pregnancy Risks
SUNDAY July 19, 2009 -- Thanks to high-profile celebrities like Brooke Shields, postpartum depression is out of the closet and discussed as something to recognize and treat.
But less well known is depression during pregnancy -- a common problem as well, and one that also can be risky for the unborn baby, experts now know.
A depressed woman, for instance, is more likely to give birth early, increasing health risks for the baby.
Depression during pregnancy is more common than most people believe, agree Dr. De-Kun Li, a reproductive perinatal epidemiologist in the research division at Kaiser Permanente in Oakland, Calif., and Dr. Diana Dell, a psychiatrist and obstetrician-gynecologist at Duke University Medical Center in Durham, N.C.
One or two of every 10 pregnant women have symptoms of major depression, according to the March of Dimes. Those who have had a bout of depression before are more likely to get it again. And Li said that others might have depressive symptoms -- short of clinical depression but still bothersome and unhealthy.
In his recent study of 791 pregnant women, Li found that 44 percent had depressive symptoms, about half of them severe, during pregnancy. "It wasn't necessarily clinical depression," he said, but a mood noticeably low.
Li tracked the women through delivery and found that those with depressive symptoms had nearly twice the risk of delivering a baby early, before 37 weeks.
Early delivery, by itself, is associated with health risks, he said. "Premature delivery is the No. 1 cause of infant mortality," he said. His findings were published in the January 2009 issue of Human Reproduction.
"We don't know the mechanism" of why depression and early delivery are linked, Li said. But what's certain is that "depression is not a benign condition," he said. "It can be harmful to your baby."
What about antidepressant use during pregnancy?
"What I tell patients who see me in consultation [for depression] is that moms need to be well in pregnancy," Dell said.
That may or may not mean taking antidepressants, she said. There have been no head-to-head comparisons of antidepressants during pregnancy to determine which are safest, she said, making it difficult to know, if medication is needed, which to choose.
In 2008, the American College of Obstetricians and Gynecologists updated its bulletin, "Use of Psychiatric Medications During Pregnancy and Lactation." In it, the group notes that more than 500,000 pregnancies in the United States each year involve women who have psychiatric illnesses -- depression, but other illnesses as well -- that occurred before the pregnancy or emerge with it.
In the bulletin, the college experts offer a number of recommendations, including the suggestion that pregnant women avoid the antidepressant paroxetine (Paxil). In 2005, the U.S. Food and Drug Administration issued a warning about Paxil based on studies that found that it might increase the risk of birth defects.
Other reports have found that babies born to women who are taking a type of antidepressant known as an SSRI (selective serotonin reuptake inhibitor) could have breathing or feeding problems, according to the March of Dimes.
The bulletin recommends that treatment with antidepressants be individualized.
Antidepressants, though, aren't the only option to treat depression during pregnancy, Dell said. Other options include talk or cognitive therapy. Some women might find help through a support group, according to the March of Dimes. And, if a woman has the type of depression known as seasonal affective disorder, which returns in the fall and winter when less light is available, light therapy might help, according to the March of Dimes.
What is crucially important, Li and Dell agree, is for a woman who is pregnant and thinks she is depressed to alert her physician. Together, they can weigh the pros and cons of treatment and decide what would be best for her and the baby.
The March of Dimes has more on depression during pregnancy.
Posted: July 2009
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