Pregnant Women on Antidepressants Less Likely to Breastfeed

Researchers at the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide non-profit organization based at the University of California, San Diego School of Medicine, have found women exposed to certain antidepressants during pregnancy were significantly less likely to breastfeed their babies compared to unexposed women. The results of the study were recently published online in The Journal of Human Lactation.

The study uses data obtained by counselors at the CTIS Pregnancy Health Information Line, a toll-free service offering evidence-based clinical information about exposures during pregnancy and breastfeeding. It focused on 466 pregnant women who contacted the CTIS Pregnancy Health Information Line over a ten year period with questions about a wide variety of exposures and, after being counseled, agreed to participate in a follow-up study of their pregnancy outcome.

The study specifically examines breastfeeding choices of women exposed to selective serotonin reuptake inhibitor (SSRI) antidepressants at the time of delivery, compared to those who discontinued use of antidepressants earlier in pregnancy, as well as to those women who report not taking antidepressants at all. The results showed women exposed to an SSRI anytime in pregnancy were about 60 percent less likely to initiate breastfeeding than women who took no antidepressant.

“While the benefits of breastfeeding an infant are very clear, this study suggests that women who are taking antidepressants in pregnancy are not engaging in this behavior as often as we would like to see,” said Christina Chambers PhD, MPH, professor of pediatrics at UC San Diego School of Medicine, CTIS program director, and co-author of the study. “Whether this is due to the mother’s fear of harming her baby by breastfeeding while taking the medication, or due to the mother’s depression itself is unclear.” According to Chambers, regardless of the reason for breastfeeding choice, the study suggests that women who have depressive disorders and/or take antidepressants in pregnancy may require additional encouragement and support when making the choice to breastfeed an infant.

Pregnancy And Antidepressants
A group of U.S. researchers, led by University Hospitals of Cleveland and Case Western Reserve University psychiatrist Katherine L. Wisner, M.D., has compiled a review of new studies on antidepressant use among pregnant women. The review is designed to guide general physicians and obstetricians who treat pregnant women.

The article appears in the October 6,1999 issue of the Journal of the American Medical Association.

The risk for depression among all women of childbearing age is as high as 25 percent for women 25- through 44-years-old. Physicians traditionally have been reluctant to treat major depression with drug therapy in pregnant women because of safety concerns. Therefore, many pregnant women have been forced to choose between the debilitating effects of untreated depression and the unknown effects of antidepressant drug therapy on their pregnancy.

Dr. Wisner and her group (from the American Psychiatric Association’s Committee on Research on Psychiatric Treatments) compiled and evaluated data from four drug-specific studies that were published since 1993. They organized data into five categories of reproductive toxicity: intrauterine fetal death, physical malformations, growth impairment, behavioral abnormalities and neonatal toxicity.

They found that tricyclic antidepressants, fluoxetine (Prozac), and newer selective serotonin reuptake inhibitors (SSRI) did not increase the risk for intrauterine fetal death or major birth defects.

They also found that exposure to tricyclic antidepressants and newer SSRI’s did not increase the risk for growth impairment. However, there were no solid conclusions on the risk that fluoxetine posed on prenatal growth and birth weights of infants.

Questions or concerns about antidepressants or any other exposure during pregnancy or breastfeeding can be directed to the CTIS Pregnancy Health Information Line at 800-532-3749 or via instant message counseling at Outside of California, please call the Organization of Teratology Information Specialists (OTIS) at 866-626-6847

Antidepressants are a primary treatment option for most types of depression. Antidepressants can help relieve your symptoms and keep you feeling your best — but there’s more to the story when you’re pregnant or thinking about getting pregnant. Here’s what you need to know about antidepressants and pregnancy.

How does pregnancy affect depression?
Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn’t true. In addition, pregnancy can trigger a range of emotions that make it more difficult to cope with depression.

Is treatment important during pregnancy?
Depression treatment during pregnancy is essential. If you have untreated depression, you might not have the energy to take good care of yourself. You might not seek optimal prenatal care or eat the healthy foods your baby needs to thrive. You might turn to smoking or drinking alcohol. The result could be premature birth, low birth weight or other problems for the baby — and an increased risk of postpartum depression for you, as well as difficulty bonding with the baby.

Are antidepressants an option during pregnancy?
A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is low. Still, few medications have been proved safe without question during pregnancy and some types of antidepressants have been associated with health problems in babies.


Dr. Leslie W. Tam
Dr. Leslie W. Tam specializes in reproductive psychiatry and has a private practice in San Diego, CA. She is a founding member of the Postpartum Health Alliance, a non-profit dedicated to raising awareness about postpartum emotional disorders and providing support and treatment referrals to women who are struggling with them. As a supporter of CTIS, Dr. Tam has referred many of her patients to the CTIS Pregnancy Health Information Line.

Source: University of California, San Diego Health Sciences

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