Despite concerns that antidepressant use during pregnancy could affect infants’ growth and development, a small new study finds no size differences in the first year of life between babies exposed and not exposed to the drugs.

The medications, known as selective serotonin reuptake inhibitors, or SSRIs, which include fluoxetine (marketed as Prozac) and citalopram (Celexa), have been tied to premature births and lower birth weight. But their affect on growth during infancy had not been studied.
“It’s a reassuring finding in that when you have an illness during pregnancy, you want to know what is the impact of the illness and what is the impact of the medication,” lead author Dr. Katherine Wisner told Reuters Health.

Untreated depression also didn’t seem to influence infant growth, according to Wisner, the director of Northwestern University’s Asher Center for the Study and Treatment of Depressive Disorders.

That’s important because a baby’s most rapid growth happens in the first year - which sets the stage for growth patterns for the whole lifespan, she added.

Wisner and her colleagues tracked 97 pregnant women with no depression, 46 on antidepressants and 31 with depression not treated with medication. Their babies were measured and weighed four times over the first year of life.

Almost 20 percent of women on SSRIs gave birth prematurely - before 37 weeks of gestation - compared to 10 percent of depressed, non-medicated women and 5 percent of women without depression, consistent with previous studies.

However, neither depression nor SSRIs were associated with lower weight, shorter length or smaller head size at two weeks, three months, six months and one year.

“This is a good study with some significant limitations, which is inherent in this kind of work,” according to Dr. Richard Shelton, a psychiatrist who studies antidepressants and pregnancy at the University of Alabama at Birmingham and was not involved in the study.

Had the study found an association between the drugs and infant growth, it would have been hard to say whether the change was linked to the antidepressants themselves, he told Reuters Health.

That’s because women who take medication for their depression and those who don’t tend to be different in many ways which could affect pregnancy outcomes, Shelton said. People on medication are likely more severely depressed, for one, and may have other medical conditions, such as obesity, that aggravate depression.

Previous studies have found babies exposed to SSRIs tend to have more problems immediately after birth, Shelton said.

Babies can be less responsive and more irritable, which may be caused by withdrawal from the drugs they’ve had in their systems, Shelton said. One of his studies also found SSRI-exposed babies had a slightly increased risk of seizures after birth (see Reuters Health story of May 30, 2012 here: reut.rs/KHNQUe).

Depression alone has been linked to risks as well, including low birth weight, Wisner said. There’s also a large body of evidence on the risks of growing up in a home with a depressed mom on a child’s psychological development.

Wisner has received grant money for Pfizer, which markets antidepressants. The current study - published in The American Journal of Psychiatry - was funded by the National Institute of Mental Health.

Whether or not a woman stays on antidepressants during pregnancy remains a personal decision, and every individual needs to consult with her doctor and weigh the risks and benefits in her own unique case, Wisner said.

But she emphasized that both drug and non-drug treatments are available for depression - so pregnant women should not be afraid to seek help.

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SOURCE: The American Journal of Psychiatry, March 20, 2013