Antidepressant Use During Pregnancy
Depression and anxiety disorders are common during pregnancy.
Perinatal depression (depression during pregnancy or after the baby’s birth) can be very serious for both you and your baby and it is therefore very important that you receive proper treatment. If depression is not treated properly it can make it hard to care for your own and your baby’s needs and may make forming emotional bonds difficult.
Women who stop taking antidepressants just before they become pregnant, or early in pregnancy, have a higher chance of relapsing into depression by the time they give birth. Untreated depression can also affect the baby in the womb and result in emotional and behavioural difficulties later on in childhood.
The decision about how best to treat depression in pregnancy is an individual one and we recommend a detailed discussion with your GP, who may also recommend psychological support services.
Overall it is thought that the risks of not treating more severe cases of depression outweigh the risks of antidepressants to both you and your baby.
Will antidepressant medication affect my baby?
What we understand about the risks to babies of antidepressant use in mothers is based mostly on observational studies rather than experiments set out to assess them. Therefore it is hard to be certain if outcomes result from the medicines themselves or other factors in people’s lives.
Antidepressants do pass through the placenta to your baby and some studies have suggested that they may be responsible for a small increase in the risk of congenital heart problems. Other studies have not shown this to be the case. It is not known if they increase rates of miscarriage, preterm birth or low birth weight due to conflicting study results.
Babies born to mothers on antidepressants, may have mild symptoms of withdrawal which can include jitteriness, poor feeding, agitation and fast breathing. These symptoms usually disappear without the need for any treatment, within the first two weeks of life.
There is a slightly increased risk to these babies of a condition known as Persistent Pulmonary Hypertension of the Newborn (PPHN). PPHN is a very rare but potentially very serious problem causing breathing difficulties in the newborn. In order to exclude PPHN and to monitor any withdrawal symptoms we recommend that babies born to mothers who have been taking antidepressants from 28 weeks onwards are observed with their mothers on the postnatal ward for a minimum of 24 hours following delivery.
Can I breastfeed whilst taking antidepressants?
If you have been taking an antidepressant while you are pregnant, you should usually be able to continue on the same medication as the amount in breastmilk is much less than the baby would have got while you were pregnant. There is evidence to suggest that antidepressant use while breastfeeding is not harmful in terms of your baby’s developmental milestones and preschool performance.
Overall, breastfeeding in women who are taking antidepressants is generally considered to be safe, although there are exceptions and it is therefore important to discuss what medication you are taking with your midwife during the pregnancy in order to have a clear plan in place for the delivery. Your midwife may choose to refer you to the Infant Feeding Specialist Midwife for advice as needed. If your baby is born prematurely or has any health problems it may not be advisable for you to breastfeed if you are taking antidepressants. This will be discussed with you.
What are my birth options if I am taking antidepressants?
We would recommend delivery on the Mendip Birth Centre or the Central Delivery Suite, both at Southmead Hospital. Birth at Cossham Birth Centre would not be advisable.