Moms’ Antidepressants May Affect Babies’ Head Size: Study

MONDAY, March 5 (HealthDay News) — Pregnant women taking certain
antidepressants may be more likely to deliver infants with reduced head
growth, a new study suggests.

The researchers also found that although selective serotonin reuptake
inhibitors (SSRIs) such as Paxil and Prozac relieved depression in these
women, they appeared to be associated with a higher risk of preterm
birth.

“Fetal body growth is a marker of fetal health and fetal head growth is
a marker for brain development,” said lead researcher Hanan El Marroun, a
postdoctorate fellow in the department of child and adolescent psychiatry
at Sophia Children’s Hospital and Erasmus Medical Center in Rotterdam, the
Netherlands. “We found prenatal exposure to SSRIs was associated with
decreased growth of the head, but not decreased growth of the body.”

In mothers with untreated depression, the babies had smaller growth in
both the body and head, the investigators found.

“If the depression is untreated, it affected the whole body; but if the
mother used SSRIs, the head growth of the fetus was affected,” El Marroun
noted. “This may mean that smaller head growth is not explained by
depression, but by the SSRIs.”

This suggests that imbalance in the brain’s serotonin — a chemical
that helps the brain send signals from one area to another — is not good
for infants’ developing brains, she said. SSRIs specifically target
serotonin.

“We don’t know what this means for the long-term development of these
children,” El Marroun said.

Doctors might be prescribing SSRIs too often, and there may be
alternatives for pregnant women, she suggested. “Sometimes depression can
be treated without medication,” El Marroun said.

The report was published in the March 5 online edition of the
Archives of General Psychiatry.

For the study, El Marroun’s team studied birth outcomes in nearly 7,700
pregnant women.

Among these women, 91 percent had no or very mild symptoms of
depression, about 7 percent had symptoms of depression but did not take
SSRIs, and just over 1 percent were depressed and used SSRIs during
pregnancy.

Women who were depressed but did not take SSRIs tended to have babies
that had smaller bodies and heads, while women who used SSRIs tended to
have infants with smaller heads but not smaller bodies, the study
found.

Children of mothers using SSRIs had less head-circumference growth than
children of depressed mothers not treated with SSRIs, although these
babies also showed a reduced growth of head circumference.

Fetal head circumference may be an indicator of brain weight, and small
head size in infants from birth to 4 weeks of age may be predictive of
behavioral problems and psychiatric disorders, the researchers noted.

However, “we must be careful not to infer an association of SSRI use in
pregnancy with future developmental problems,” the researchers stated in
their report.

In addition, the investigators found that children of depressed mothers
who did not use SSRIs were born slightly later than usual (about one day).
Children of mothers who used SSRIs were twice as likely to be born
preterm.

This study shows only an association and not a cause-and-effect
relationship between SSRIs, depression and birth outcomes, El Marroun
cautioned.

The findings add to the growing literature on the risks associated with
SSRIs and depression, and suggest that the choices women make about using
SSRIs during pregnancy are difficult, said Michael O’Hara, a professor of
psychology at the University of Iowa in Iowa City.

“One thing is disturbing about the paper,” O’Hara said. “It ignores the
fact that antidepressant medication is only one approach to the treatment
of depression during pregnancy or any other time.”

There is evidence that psychological treatments for depression can be
used during pregnancy, or earlier for women who plan their pregnancies,
O’Hara said.

“These psychological treatments allow a woman to avoid antidepressant
medication, but at the same time receive very good treatment for their
depression,” he said.

Although some depressed pregnant women will need antidepressants, the
majority do not require the medication if they are receiving psychological
care, such as interpersonal psychotherapy or behavioral therapy, O’Hara
added.

More information

For more about depression during pregnancy, visit the U.S. Department
of Health and Human Services Office on Women’s Health.

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