Date of Graduation

8-15-2009

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

Judy Ortiz MHS, MS, PA-C

Second Advisor

Rob Rosenow PharmD, OD

Third Advisor

Annjanette Sommers MS, PA-C

Abstract

Introduction: A significant number of women suffer depression prior to and during pregnancy. Untreated depression is associated with suboptimal prenatal care and often severe adverse outcomes. Selective serotonin reuptake inhibitors (SSRIs) are commonly used antidepressants that have been inconsistently implicated in adverse pregnancy and neonatal outcomes. The clinical question of whether a woman with perinatal depression should choose SSRI treatment or forego it, is a common one encountered by clinicians in primary care, and one without a satisfactory answer.

Methods: A systematic review of the past five years of English-language published literature was conducted using MEDLINE, CINAHL, and ISI Web of Science using keywords depression, pregnancy, SSRI, and subordinate headings. Articles of original research examining outcomes of SSRI exposure during pregnancy were selected. Meta-analyses and case reports or series were excluded. Fifteen studies, three of which compared SSRI exposure to untreated depression, were retrieved and analyzed for quality and significant results.

Results: Multiple significant relationships between SSRIs and birth defects and between SSRIs and adverse neonatal outcomes were reported, but few results were in agreement across studies, and fewer results were of statistical or clinical significance after adjustments for known confounders were completed. Limited results showed that SSRI exposure and untreated depression carry similar risks to mother and child.

Discussion: Current guidelines suggest individualized treatment for women with perinatal depression. Additional prospective research efforts, perhaps even randomized placebo-controlled trials, are needed to quantify and qualify possible risks of SSRI exposure in pregnant women. Such work should be on large populations and should control for depression as an independent risk factor.

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