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Beneficial and harmful consequences of prepartum and postpartum antidepressant exposure

Since women are twice as likely as men to experience depression, and depression mainly occurs during their reproductive years, high rates of depression during pregnancy and postpartum are expected.1 Epidemiological data suggest that the prevalence of major depression in pregnant women is in the range of 3–5%, and the combined prevalence of major and minor depression can reach 8–11%.2 ,3 Postpartum depression, which indicates a major depressive episode that occurs within the first 4 weeks after delivery or, using broader clinical criteria, within the first year after childbirth, may affect up to 13% of women.4 ,5

As a consequence, a relevant and growing number of women are exposed to antidepressants (ADs) during pregnancy, after delivery and over the following months. On average, 1–8% of women receive AD medication during pregnancy, with higher prevalence of use during the first trimester.1 In the USA, a recent study showed that prenatal visits associated with AD prescriptions had increased from 0.7% (2002–2006) to 2.1% (2007–2010).6 In Denmark, a 16-fold increase in exposure rates between 1997 and 2010 was observed, from a rate of 0.2% in 1997 to 3.2% in 2010.7 After delivery and during the first year after childbirth the prevalence of AD prescriptions may steadily increase, as recently suggested by a Danish population-based prevalence study.8

The combination of depression and AD use during pregnancy and postpartum has been associated with harmful consequences in terms of neonatal and child development outcomes.

An increased risk of physical and emotional/behavioural problems has consistently been observed in the offspring of mothers suffering from depression in the perinatal period.9 ,10 Probably, complex interactions between several pathways may explain this phenomenon, including biological mechanisms (eg, fetal exposure to maternal stress hormones), behavioural and emotional features (eg, poorer prenatal care …