Associations Between Maternal Depression, Antidepressant Use During Pregnancy, and Adverse Pregnancy Outcomes: An Individual Participant Data Meta-analysis.

To evaluate the associations of depressive symptoms and antidepressant use during pregnancy with the risks of preterm birth, low birth weight, small for gestational age (SGA), and low Apgar scores. MEDLINE, EMBASE, ClinicalTrials.gov, and PsycINFO up to June 2016. Data were sought from studies examining associations of depression, depressive symptoms, or use of antidepressants during pregnancy with gestational age, birth weight, SGA, or Apgar scores. Authors shared the raw data of their studies for incorporation into this individual participant data meta-analysis. We performed one-stage random-effects meta-analyses to estimate odds ratios (ORs) with 95% CIs. The 215 eligible articles resulted in 402,375 women derived from 27 study databases. Increased risks were observed for preterm birth among women with a clinical diagnosis of depression during pregnancy irrespective of antidepressant use (OR 1.6, 95% CI 1.2-2.1) and among women with depression who did not use antidepressants (OR 2.2, 95% CI 1.7-3.0), as well as for low Apgar scores in the former (OR 1.5, 95% CI 1.3-1.7), but not the latter group. Selective serotonin reuptake inhibitor (SSRI) use was associated with preterm birth among women who used antidepressants with or without restriction to women with depressive symptoms or a diagnosis of depression (OR 1.6, 95% CI 1.0-2.5 and OR 1.9, 95% CI 1.2-2.8, respectively), as well as with low Apgar scores among women in the latter group (OR 1.7, 95% CI 1.1-2.8). Depressive symptoms or a clinical diagnosis of depression during pregnancy are associated with preterm birth and low Apgar scores, even without exposure to antidepressants. However, SSRIs may be independently associated with preterm birth and low Apgar scores. PROSPERO, CRD42016035711.

Informations de copyright

Copyright © 2021 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

Financial Disclosure Hanan El Marroun disclosed that she received a NARSAD Young Investigator Grant 27853 from the Brain & Behavior Research Foundation. Money was paid to her institution under grant agreement 733206 (LifeCycle) from the European Union's Horizon 2020 Research and Innovation Program and from Erasmus University Rotterdam Fellowship 2014. They also disclosed receiving funding from Stichting Volksbond Rotterdam, ongoing, paid to the institution. Frank M.M.A. van der Heijden disclosed receiving funding from Janssen-Cilag, and Recordati. J. Jo Kim disclosed their institution received funding from the Patient-Centered Outcomes Research Institute and the National Institute of Mental Health. Marius Lahti-Pulkkinen received funding from the Academy of Finland. Dawn Misra disclosed receiving funding from the NIH. Kate E. Pickett disclosed that money was paid to her institution from UKRI and Wellcome Trust. Henning Tiemeier disclosed money was paid to their institution from the Dutch Research Medical Council. Heather J. Zar disclosed that money was paid to her institution from the Bill & Melinda Gates Foundation and the SA MRC. The other authors did not report any potential conflicts of interest.