Abstract
Purpose: Depressive disorders are related to obstetrical and neonatal complications. The purpose of this study is to evaluate the outcomes of pregnancy in women suffering from depressive disorders, who are treated or not treated with pharmacotherapy during pregnancy. Methods: The maternal and neonatal outcomes of 281 pregnant women with depressive disorders (D group—DG), who delivered their babies at Sant’Anna Hospital of Turin, were compared with those of a control group of 200 depression-free, healthy, pregnant women, who were matched for maternal age (C group—CG). Of the depressed patients, those who received pharmacotherapy during pregnancy (DG-Tr, n = 199, 70.8%) were compared with those who did not (DG-Untr, n = 82, 29.2%). The comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. A linear regression analysis was run to examine the association between APGAR scores at 5 min and certain clinical variables. Results: The women in DG showed higher rates of cesarean section, preterm delivery, induction of labor and SGA babies, and low neonatal weights and 5-min APGAR scores, compared to the untreated patients. Those treated with psychotropic drugs showed lower rates of cesarean section, but lower 5-min APGAR scores, compared to those who were untreated. However, after controlling for confounding variables, the 5-min APGAR scores were linearly associated with neonatal weight and not with the use of psychotropic treatment. No significant differences were observed between the treated and untreated women, regarding the rates of preterm delivery, induction of labor, SGA and low neonatal weight. Conclusion: In pregnant patients with depressive disorders, poorer outcomes are expected vs. healthy controls. Pharmacological treatment is associated with a reduced rate of cesarean section, without inducing other complications for the mother and the newborn.
Highlights
Pregnancy and puerperium are considered high-risk time periods for the onset or recurrence of depression [1]
Using over ten years of clinical data, the aim of the present study is to evaluate the outcomes of pregnancy and delivery, as well as newborns’ health, in women suffering from depressive disorders, who were treated or not treated with pharmacotherapy during gestation, distinguishing the effects of the disease from those of its treatment
The rates of preterm delivery, small for their gestational age (SGA), induced labor and cesarean section were significantly higher in the DG than among the controls, whereas neonatal weight and APGAR scores at 5 min post-partum were significantly lower
Summary
Pregnancy and puerperium are considered high-risk time periods for the onset or recurrence of depression [1]. Up to 70% complain of depressive symptoms during pregnancy, and 10–16% of them fulfill the criteria of true depressive disorders [2–5]. A depressive disorder during the peri-partum period can interfere with 4.0/). Normal feelings of motherhood and newborn care [6]. These women need greater attention and multi-disciplinary care [7]. The decision to treat depressive disorders during pregnancy with psychotropic medications should be carefully considered, weighing the risk of prenatal exposure to drugs vs. Antidepressant therapy should not be discontinued during pregnancy, but should be modified by choosing only one drug at the lowest effective dosage. A slight increase in fetal toxicity is reported for tricyclic antidepressants, such as amitriptyline, imipramine and nortriptyline, while paroxetine, taken in the first trimester, may be associated with fetal heart defects, and venlafaxine with an increased risk of high blood pressure at high doses [11–13]
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