The risks associated with prenatal antidepressant exposure: time for a precision medicine approach

ABSTRACT

Introduction: The prevalence of depression in pregnancy is over 10% and a significant proportion of pregnant women use antidepressant medication. The safety of antidepressants in pregnancy is controversial, partly due to methodological challenges. The conflicting results in the literature may, however, also be due to differences in risks between the study populations related to variations in e.g. degree of depression, type of antidepressant, and lifestyle.

Areas covered: The literature on the safety of antidepressants in pregnancy is vast and thousands of papers have been published mainly in the last decades. This paper summarizes the evidence on important outcomes, including malformations, obstetric and neonatal outcomes, and long-term effects. It further describes results indicating that genetic variations in e.g. metabolism need to be taken into account.

Expert opinion: Use of antidepressants during pregnancy must balance between the risks related to the underlying disease and the risks of antidepressant use. This balance needs to include information on a number of factors, including degree of depression and life-style. More data are required on how to include genetic information in the counseling. Overall, emerging evidence points to the need for a precision medicine approach to the treatment of pregnant women with depression.

KEYWORDS:

• Antidepressants
• precision medicine
• pregnancy
• teratology

Article highlights

• Depression is common during pregnancy and is per se associated with significant risks

• Antidepressants have been associated with risks of e.g. specific malformations and abnormal fetal brain development

• These risks are controversial and some of the associations may be caused by other factors, e.g. maternal depression

• The complexity of the existing literature and the controversies may hamper safe management of pregnant women with depression

• A precision medicine approach is a promising but mandates targeted research

This box summarizes key points contained in the article.

Declaration of interest

The author has reported no conflict of interest.

Additional information

Funding

LHP is funded by the Health Research Fund of Central Denmark Region (project 490-79-5601). The funder had no role in the preparation of the manuscript.