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 Researchers examined brain scans of 16 newborns whose mothers took
medications known as selective serotonin reuptake inhibitors (SSRIs)
for depression during pregnancy. They also studied 21 babies whose
mothers had untreated depression during pregnancy, and 61 infants
born to women without depression.
Infants whose mothers took SSRIs had greater brain volume in regions
of the brain that are critical for emotional processing, compared to
babies whose mothers had untreated depression or were not
experiencing depression, the study found.
"Based on our study and those of other researchers, we can say with
some confidence that SSRI medications have an influence of fetal
brain development," said study coauthor Jiook Cha, of the New York
State Psychiatric Institute and Columbia University Irving Medical
Center in New York City.
"Exactly what that influence means over the longer term with regard
to the infant's cognitive and emotional development remains unclear
and requires subsequent research to really understand," Cha said by
email.
The current study doesn't prove antidepressants directly cause
abnormal brain development or cognitive and emotional problems. It
also doesn't explore the potential harms of untreated depression or
assess whether remedies other than medication might be safer or more
effective for women and their babies.
Left untreated, depression during pregnancy is associated with
underweight babies who are more likely to wind up in intensive care
units immediately after birth. Pregnant women with uncontrolled
depression may not eat well or keep up with prenatal visits, and in
the most severe cases, they may be at increased risk for suicide.
Like many drugs, antidepressants fall into a gray area during
pregnancy, with insufficient evidence to definitively prove the
harms or benefits. Often, doctors may reserve drugs for women with
more severe depression.
In the current study, babies exposed to SSRIs in utero had greater
brain volume in the amygdala and the insular cortex, regions thought
to be involved in regulating mood, and intensive feelings like fear
and joy.
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Infants exposed to antidepressants in the womb also had increased
connectivity between these regions of the brain, researchers report
in JAMA Pediatrics.
Beyond its small size, another limitation of the study is that
mothers weren't randomly selected to take SSRIs when they had
depression. This makes it hard to rule out the possibility that
women with more severe symptoms used the medications and that any
changes in babies brains might be due to the severity of depression
and not the drugs.
"Maternal depression and SSRI use during the second and third
trimester of pregnancy when the brain develops are both independent
risk factors for lower cognitive function in children," said Anick
Berard, who researches medication use during pregnancy at the
University of Montreal in Canada.
Some animal and human studies, however, have linked SSRIs to an
increased risk of autism as well as delayed motor skills in babies,
Berard, who wasn't involved in the study, said by email.
While there are still many unanswered questions about the potential
effects of SSRI use during pregnancy on babies' brain development,
it makes sense for women to consider these risks when they weigh the
best way to treat depression during pregnancy, Cha said.
For some women, psychotherapy or other medications may be an option,
Cha advised. But women should also consider the risks associated
with untreated depression.
"Maternal depression increases the risk for negative pregnancy
outcomes such as low birth weight and prematurity," Cha said. "It
can also lead to postpartum depression with effects on mother-infant
bonding.
SOURCE: http://bit.ly/2GKQz5N JAMA Pediatrics, online April 9, 2018.
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