Major depressive disorder during pregnancy: Psychiatric medications have minimal effects on the fetus and infant yet development is compromised

• Type of Material: Article
• Authors: HANNA C. Gustafsson, Oregon Health and Science University; Sherryl Goodman, Emory University; TIANSHU Feng, New York State Psychiatric Institute; JEAN Choi, New York State Psychiatric Institute; SEONJOO Lee, New York State Psychiatric Institute; D. JEFFREY Newport, University of Miami; BETTINA Knight, University of Arkansas; BLAIRE Pingeton, Columbia University; ZACHARY N. Stowe, University of Wisconsin; CATHERINE Monk, New York State Psychiatric Institute
• Language: English
• Date: 2018-08-01
• Publisher: Cambridge University Press (CUP): STM Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Copyright 2018 Cambridge University Press.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1017/S0954579418000639
• Title of Journal or Parent Work: Development and Psychopathology
• ISSN: 0954-5794
• Volume: 30
• Issue: 3
• Start Page: 773
• End Page: 785
• Grant/Funding Information: Research reported in this publication was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR002371.; This study was supported by the Translational Research Center in Behavioral Sciences (TRCBS) Grant P50 MH077928.
• Keywords: NEUROBEHAVIORAL DEVELOPMENT; ANTIEPILEPTIC DRUGS; FETAL HEART-RATE; Psychology; PLACENTAL PASSAGE; SEROTONIN REUPTAKE INHIBITORS; AUTISM SPECTRUM DISORDER; PRENATAL EXPOSURE; MATERNAL DEPRESSION; Social Sciences; PERINATAL DEPRESSION; ANTIDEPRESSANT USE; Psychology, Developmental
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Medicine and Surgery; Health Sciences, Human Development

Abstract

Psychotropic medication use and psychiatric symptoms during pregnancy each are associated with adverse neurodevelopmental outcomes in offspring. Commonly, studies considering medication effects do not adequately assess symptoms, nor evaluate children when the effects are believed to occur, the fetal period. This study examined maternal serotonin reuptake inhibitor and polypharmacy use in relation to serial assessments of five indices of fetal neurobehavior and Bayley Scales of Infant Development at 12 months in N = 161 socioeconomically advantaged, non-Hispanic White women with a shared risk phenotype, diagnosed major depressive disorder. On average fetuses showed the expected development over gestation. In contrast, infant average Bayley psychomotor and mental development scores were low (M = 84.10 and M = 89.92, range of normal limits 85-114) with rates of delay more than 2-3 times what would be expected based on this measure's normative data. Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant. Mental health care directed primarily at symptoms may not address the additional psychosocial needs of women parenting infants. Speculatively, prenatal serotonin reuptake inhibitor exposure may act as a plasticity rather than risk factor, potentially enhancing receptivity to a nonoptimal postnatal environment in some mother-infant dyads.