Medical News

Medical information is always changing. Don’t assume your health practitioner has the latest information about treatment of pregnancy and postpartum mood/anxiety disorders. Here are some summaries from recent medical research.

Will eating my placenta prevent postpartum blues or depression?

There have been a number of recent articles in the media reporting stories of women who claim that eating the placenta after a birth prevents postpartum blues and possibly to protects against postpartum depression and anxiety.  Placenta eating has been part of a number of cultural rituals around the world.  And, indeed, some animal species do eat the placenta after birth (some animals do not).  Unfortunately, this may be more about reducing a trail for prey than about postpartum health - it's an unknown.  There have been no scientific studies showing any benefit physically or emotionally as a result of eating your placenta.  There is no evidence that it will hurt you, but there is no evidence of any health benefit.  Remember that 30% of people will feel better when given a placebo or "sugar pill". 

What about antidepressants and breast feeding?  Here’s what a couple of highly respected experts said:

“Any of the antidepressants are OK to use and breastfeed…The woman should take whichever one is effective for her.”

Adrienne Einarson, R.N. Assistant Director of Clinical Services Motherisk Program, Toronto, Canada (http://www.motherisk.org)

“As a class, antidepressants have more detailed data in breastfeeding than any other class of medications.”

Zachary Stowe, M.D., Emory Women’s Mental Health Program Director, Atlanta, GA

Do SSRI’s (a common type of antidepressants) Cause Birth Defects When Taken in Pregnancy?

» A new study from the Mayo Clinic, published in January 2009, reviewed records of over 25,000 deliveries. Of those women, 808 were on antidepressants at some time during their pregnancies.  There were heart defects in 0.8% of the women not on antidepressants.  (Remember, birth defects occur in 3-5% of all babies).  In the women taking antidepressants, heart defects were seen in 0.4% of the babies.  There were 16 newborns diagnosed with Persistent Pulmonary Hypertension of the Newborn - all from the moms who were not on medication.  In other words, the moms who took antidepressants had babies with a lower rate of heart defects, and no pulmonary effects. They concluded that the data was very reassuring regarding the safety of SSRI’s in pregnancy.  Wichman, et al., Mayo Clin Proc. January 2009;84(1):23-27 , www.mayoclinicproceedings.com

Do Antidepressants Cause PPHN (Persistent Pulmonary Hypertension Of The Newborn)?

» In 2006, the Federal Drug Administration warned healthcare providers that there may be a link between use of an SSRI antidepressant medications after 20 weeks of pregnancy and a serious lung condition in newborns.  This was based on one study done in 2006 of over 300 women.  In 2009, a review was published comparing over 1100 babies who were exposed in the third trimester of pregnancy to an SSRI, to 1100 babies not exposed.   The authors conclude  that they “did not find an association between SSRI use in pregnancy and PPHN’.  Pharmacoepidemiology and Drug Safety 2009;18:

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Major Depression and Antidepressant Treatment: Impact on Pregnancy and Neonatal Outcomes

» Women were studied at 20, 30, and 36 weeks of pregnancy.  They looked at pregnant women who were not depressed, pregnant women who were depressed and not treated, and pregnant women taking SSRI’s.  The women who took SSRI’s and the women with depression did not experience any more minor malformations or weight loss than the non-depressed women who did not take medication. Neither first-trimester nor continuous exposure to SSRIs or depression was associated with a significant increase in the number of minor anomalies (birth defects) or the proportion of infants with three or more anomalies. Infant birth weights were similar in all groups.  Babies exposed to anti-depressants were no more likely to need care in the Neonatal Intensive Care Unit (NICU) than babies not exposed to medication.  Moms who were depressed and untreated, as well as the moms on anti-depressants, were both 20% more likely to have a preterm delivery.  However, the moms on anti-depressants only delivered a week or so early.  This article is also important because it points out that babies whose moms were on medication did not have problems that required extra care or observation. March 2009, Wisner, et al, American Journal of Psychiatry

Relapse Of Major Depression During Pregnancy In Women Who Maintain Or Discontinue Antidepressants Treatment

» In this study, it was noted that 68% of the women who discontinued antidepressant treatment around the time of pregnancy became depressed again during pregnancy; of those who relapsed, approximately 50% did so in the first trimester of pregnancy and 90% became depressed by the end of the second trimester. This is compared with the 26% of women who relapsed while maintaining dosages of antidepressant (at least up until 16 weeks’ gestation) where again approximately half of those who relapsed did so in the first trimester. Don’t assume that it is always wise to stop your medications when you get pregnant.  Speak to someone who understands not just the risks of medication, but the risks of untreated illness.  This may or may not be your OB provider.  Ask questions!  Journal of the American Medical Association Feb 1, 2006 Vol 295, No 5

First-Trimester Use of Selective Serotonin-Reuptake Inhibitors And The Risk Of Birth Defects

» “Our findings do not show that there are significant increased risks of craniosynostosis (skull problem), omphalocele (defect of in the gastrointestinal system), or heart defects associated with SSRI use overall. Specific defects implicated are rare and the absolute risks are small. The risks were not appreciably or significantly increased for other defects or other SSRI’s or non-SSRI antidepressants.” The New England Journal of Medicine June 28, 2007 Vol. 356 No. 26

Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

» “Maternal use of SSRI’s during early pregnancy was not associated with significantly increased risks of congenital heart defects or of most other categories of birth defects. Associations were observed between SSRI use and three types of birth defects, but the absolute risks were small, and these observations require confirmation by other studies. “ The New England Journal of Medicine June 28, 2007 Vol.356 No. 26

Is Maternal Use Of Selective Serotonin Reuptake Inhibitors In The Third Trimester Of Pregnancy Harmful To Neonates?

» “In summary, the balance of evidence suggests that discontinuing clinically needed antidepressants in women near term is unwarranted and may put the mother at an unjustified perinatal risk (of an episode of depression or anxiety). Newborn symptoms occur in a minority of cases and go away without treatment. On the basis of currently available data, regulatory agencies and manufacturers should not perpetuate anxiety among pregnant depressed women.” Canadian Medical Association Journal May 24, 2005: 172 (11)

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