Clinical Drug Investigation

, Volume 24, Issue 3, pp 157–179 | Cite as

Depression during Pregnancy

Overview of Clinical Factors
  • Heather A. Bennett
  • Adrienne Einarson
  • Anna Taddio
  • Gideon Koren
  • Thomas R. Einarson
Review Article

Abstract

Depression during pregnancy is common, affecting an estimated 20% of women. However, conflicting data exist concerning the outcomes of this disorder. Thus, we reviewed studies that presented evidence for the use of antidepressants and those that examined untreated depression during the gestational period, in terms of clinical and epidemiological aspects.

Observational studies have provided reassuring evidence of the safety of antidepressant use during pregnancy. However, due to the reluctance of healthcare providers to prescribe and patients to take medication during the obstetric period, approximately three-quarters of those diagnosed with depression remain untreated. Furthermore, healthcare providers apparently do not recognise the disorder in up to 50% of pregnant women who experience depression. Increased antidepressant dosing during pregnancy may be required to maintain euthymia; however, guidelines for effective dosing levels are absent. Consequently, many patients remain inadequately treated. Substantial maternal and fetal morbidity including substance abuse, functional impairment, increased risk of postnatal depression, and poor pregnancy outcomes have resulted from untreated depression.

The consequences of those outcomes are likely to be associated with substantial clinical, social and economic burdens. An incidence-based assessment of the consequences of prenatal depression would be useful in order to: (i) establish the impact on the quality of life of these patients and their families; (ii) assess the associated economic burden on individual families and the healthcare system; and (iii) to provide epidemiological data to enable the provision of suitable management strategies for these patients.

Notes

Acknowledgements

This project was unfunded, and the authors have no conflicts of interest.

References

  1. 1.
    Judd LL, Akiskal HS, Maser JD, et al. A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry 1998; 55: 694–700PubMedCrossRefGoogle Scholar
  2. 2.
    Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: global burden of disease study. Lancet 1997; 349: 1498–504PubMedCrossRefGoogle Scholar
  3. 3.
    Commonwealth Department of Health and Aged Care, Australian Institute of Health and Welfare. National health priority areas report. Mental health 1998. Canberra: AIHW; 1999 AIHW Cat. No. PHE 13Google Scholar
  4. 4.
    Liu S, Prince M, Blizard B, et al. The prevalence of psychiatric morbidity and its associated factors in general health care in Taiwan. Psychol Med 2002; 32: 629–37PubMedCrossRefGoogle Scholar
  5. 5.
    Statistics Canada. Health indicators, Volume 2002, No. 1, Depression. Ottawa (ON): Statistics Canada, Canadian Institute for Health Information, 2002; Catalogue No: 82-221-XIEGoogle Scholar
  6. 6.
    Araya R, Rojas G, Fritsch R, et al. Common mental disorders in Santiago, Chile: prevalence and sociodemographic correlates. Br J Psychiatry 2001; 178: 228–33PubMedCrossRefGoogle Scholar
  7. 7.
    Blehar MC. The NIMH women’s mental health program: establishing the public health context for women’s mental health. TEN 2001; 3: 42-43 [online]. Available from URL at http://www.nimh.nih.gov/wmhc/bleharten.pdf [Accessed Jan, 2004]
  8. 8.
    Lepine JP, Gastpar M, Mendlewicz J, et al. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol 1997; 12: 19–29PubMedCrossRefGoogle Scholar
  9. 9.
    Berardi D, Leggieri G, Bertti CG, et al. Depression in primary care: a nationwide epidemiological survey. Fam Pract 2002; 19: 397–400PubMedCrossRefGoogle Scholar
  10. 10.
    Weissman MM, Olfson M. Depression in women: implications for health care research. Science 1995; 269: 799–806PubMedCrossRefGoogle Scholar
  11. 11.
    Johanson R, Chapman G, Murray D, et al. The North Staffordshire Maternity Hospital prospective study of pregnancy-associated depression. J Psychosom Obstet Gynaecol 2000; 21: 93–7PubMedCrossRefGoogle Scholar
  12. 12.
    Gotlib IH, Whiffen VE, Mount JH, et al. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 1989; 57: 269–74PubMedCrossRefGoogle Scholar
  13. 13.
    O’Hara MW. Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry 1986; 43: 569–73PubMedCrossRefGoogle Scholar
  14. 14.
    Evans J, Heron J, Francomb H, et al. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 2001; 323: 257–60PubMedCrossRefGoogle Scholar
  15. 15.
    Kelly RH, Russo J, Katon W. Somatic complaints among pregnant women cared for in obstetrics: normal pregnancy or depressive and anxiety symptom amplification revisited? Gen Hosp Psychiatry 2001; 23: 107–13PubMedCrossRefGoogle Scholar
  16. 16.
    Dayan J, Creveuil C, Herlicoviez M, et al. Role of anxiety and depression in the onset of spontaneous preterm labour. Am J Epidemiol 2002; 155: 293–301PubMedCrossRefGoogle Scholar
  17. 17.
    Einarson A, Fatoye B, Sarkar M, et al. Pregnancy outcome following gestational exposure to venlafaxine: a multicenter prospective controlled study. Am J Psychiatry 2001; 158: 1728–30PubMedCrossRefGoogle Scholar
  18. 18.
    Da Costa D Larouche J, Dritsa M, et al. Psychosocial correlate of prepartum and postpartum depressed mood. J Affect Disord 2000; 59: 31–40PubMedCrossRefGoogle Scholar
  19. 19.
    McKee MD, Cunningham D, Jankowksi KR, et al. Health-related functional status in pregnancy: relationship to depression and social support in a multi-ethnic population. Obstet Gynecol 2001; 97: 988–93PubMedCrossRefGoogle Scholar
  20. 20.
    Hobfoll SE, Ritter C, Lavin J, et al. Depression prevalence and incidence among inner-city pregnant and postpartum women. J Consult Clin Psychol 1995; 63: 445–53PubMedCrossRefGoogle Scholar
  21. 21.
    Orr ST, Miller CA. Maternal depressive symptoms and the risk of poor pregnancy outcome: review of the literature and preliminary findings. Epidemiol Rev 1995; 17: 165–71PubMedGoogle Scholar
  22. 22.
    Chokka P. Postpartum depression: part 1. Can J CME 2002; 14: 37–48Google Scholar
  23. 23.
    Pole M, Einarson A, Pairaudeau N, et al. Drug labeling and risk perceptions of teratogenicity: a survey of pregnant Canadian women and their health professionals. J Clin Pharmacol 2000; 40: 573–7PubMedCrossRefGoogle Scholar
  24. 24.
    Stuart S, O’Hara MW, Blehar MC. Mental disorders associated with childbearing: report of the biennial meeting of the Marce Society. Psychopharmacol Bull 1998; 34: 333–8PubMedGoogle Scholar
  25. 25.
    Marcus SM, Barry KL, Flynn HA, et al. Treatment guidelines for depression in pregnancy. Int J Gynecol Obstet 2001; 72: 61–70CrossRefGoogle Scholar
  26. 26.
    Wisner KL, Zarin D, Holmboe ES, et al. Risk-benefit decision making for treatment of depression during pregnancy. Am J Psychiatry 2000; 157: 1933–40PubMedCrossRefGoogle Scholar
  27. 27.
    Stewart DE. Antidepressant drugs during pregnancy and lactation. Int Clin Psychopharmacol 2000; 15: S19–24PubMedCrossRefGoogle Scholar
  28. 28.
    Abel K. Psychiatric illness and its management in pregnancy and the puerperium. Contemp Clin Gynecol Obstet 2002; 2: 59–71Google Scholar
  29. 29.
    Nonacs R, Cohen LS. Depression during pregnancy: diagnosis and treatment options. J Clin Psychiatry 2002; 63: 24–30PubMedGoogle Scholar
  30. 30.
    Ward RK, Zamorski MA. Benefits and risks of psychiatric medications during pregnancy. Am Fam Physician 2003; 66: 629–36Google Scholar
  31. 31.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: merican Psychiatric Association, 1994Google Scholar
  32. 32.
    Johnston TG, Kelly CB, Stevenson MR, et al. Plasma norepinephrine and prediction of outcome in major depressive disorder. Biol Psychiatry 1999; 46: 1253–8PubMedCrossRefGoogle Scholar
  33. 33.
    A research agenda for DSM-V. Washington, DC: American Psychiatric Association, 2002Google Scholar
  34. 34.
    First MB, Spitzer RL, Williams JB, et al. Structured clinical interview for DSM-IV (SCID-I) (User’s Guide and Interview) Research Version. New York: New York Psychiatric Institute, 2003Google Scholar
  35. 35.
    Boyd RC, Pearson JL, Blehar MC. Prevention and treatment of depression in pregnancy and the postpartum period: summary of a maternal depression roundtable: a US perspective. Arch Women Ment Health 2002; 4: 79–82CrossRefGoogle Scholar
  36. 36.
    Barrio LM, Burt VK. Depression in pregnancy: strategies for primary care management. Women’s Health Prim Care 2000; 3: 490–8Google Scholar
  37. 37.
    US Department of Health and Human Services, Public Health Service, and Agency for Health Care Policy and Research. Depression Guideline Panel. Depression in primary care: volume 1: detection and diagnosis. Clinical Practice Guideline, No. 5. Rockville (MD): AHCPR, 1993. Publication No. 93-0550Google Scholar
  38. 38.
    Sharp LK, Lipsky MS. Screening for depression across the lifespan: a review of measures for use in primary care settings. Am Fam Physician 2002; 66: 1001–8PubMedGoogle Scholar
  39. 39.
    Beck AT. An inventory for measuring depression. Arch Gen Psychiatry 1961; 4: 53–61CrossRefGoogle Scholar
  40. 40.
    Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977; 1: 385–401CrossRefGoogle Scholar
  41. 41.
    Spitzer RL, Kroenke K, Willaims JB. Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study. JAMA 1999; 282: 1737–44PubMedCrossRefGoogle Scholar
  42. 42.
    Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: development of the Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782–6PubMedCrossRefGoogle Scholar
  43. 43.
    Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 Study. JAMA 1994; 272: 1749–56PubMedCrossRefGoogle Scholar
  44. 44.
    Murray D, Cox JL. Screening for depression during pregnancy with the Edinburgh depression scale (EPDS). J Reprod Infant Psychol 1990; 8: 99–107CrossRefGoogle Scholar
  45. 45.
    Holcomb WL, Stone LS, Lustman PJ, et al. Screening for depression in pregnancy: characteristics of the Beck Depression Inventory. Obstet Gynecol 1996; 88: 1021–5PubMedCrossRefGoogle Scholar
  46. 46.
    Spitzer RL, Williams JB, Kroenke K, et al. Validity and utility of the PRIME-MD patient health questionnaire in assessment of 3000 obstetric-gynecologic patients: the PRIME-MD patient health questionnaire obstetrics-gynecology study. Am J Obstet Gynecol 2000; 183: 759–69PubMedCrossRefGoogle Scholar
  47. 47.
    Cox JL, Chapman G, Murray D, et al. Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Disord 1996; 39: 185–9PubMedCrossRefGoogle Scholar
  48. 48.
    Salamero M, Marcos T, Gutierrez F, et al. Factorial study of the BDI in pregnant women. Psychol Med 1994; 24: 1031–5PubMedCrossRefGoogle Scholar
  49. 49.
    Doris A, Ebmeier K, Shajahan P. Depressive illness. Lancet 1999; 354: 1369–75PubMedCrossRefGoogle Scholar
  50. 50.
    Farvolden P, Kennedy SH, Lam RW. Recent developments in the psychobiology and pharmacotherapy of depression: optimising existing treatments and novel approaches for the future. Expert Opin Investig Drugs 2003; 12: 65–86PubMedCrossRefGoogle Scholar
  51. 51.
    Nemeroff CB. Recent advances in the neurobiology of depression. Psychopharmacol Bull 2002; 36: 6–23PubMedGoogle Scholar
  52. 52.
    Nemeroff CB. The neurobiology of depression. Sci Am 1998; 278: 42–9PubMedCrossRefGoogle Scholar
  53. 53.
    Nestler EJ, Barrot M, DiLeone RJ, et al. Neurobiology of depression. Neuron 2002; 34: 13–25PubMedCrossRefGoogle Scholar
  54. 54.
    Pfost KS, Stevens MJ, Lum CU. The relationship of demographic variables, antepartum depression, and stress to postpartum depression. J Clin Psychol 1990; 46: 588–92PubMedCrossRefGoogle Scholar
  55. 55.
    Chrousos GP, Torpy DJ, Gold PW. Interactions between the hypothalamic-pituitary-adrenal axis and the female reproductive system: clinical implications. Ann Intern Med 1998; 129: 229–40PubMedGoogle Scholar
  56. 56.
    Holsboer F. Stress, hypercortisolism and corticosteroid receptors in depression: implicatons for therapy. J Affect Disord 2001; 62: 77–91PubMedCrossRefGoogle Scholar
  57. 57.
    Weissman MM, Bland RC, Canino GJ, et al. Cross-national epidemiology of major depression and bipolar depression. JAMA 1996; 276: 293–9PubMedCrossRefGoogle Scholar
  58. 58.
    Eaton WW, Anthony JC, Gallo J, et al. Natural history of diagnostic Interview Schedule/DSM-IV major depression: the Baltimore Epidemiologic Catchment Area follow-up. Arch Gen Psychiatry 1997; 54: 993–9PubMedCrossRefGoogle Scholar
  59. 59.
    Parikh SV, Lam RW. Clinical guidelines for the treatment of depressive disorder: 1. definitions, prevalence, and health burden. Can J Psychiatry 2001; 46: 13–20SGoogle Scholar
  60. 60.
    Thornicroft G, Sartorius N. The course and outcome of depression in different cultures: 10-year follow-up of the WHO collaborative study on the assessment of depressive disorders. Psychol Med 1993; 23: 1023–32PubMedCrossRefGoogle Scholar
  61. 61.
    Keller MB. Recovery in major depressive disorder: analysis with the life table and regression models. Arch Gen Psychiatry 1982; 39: 905–10PubMedCrossRefGoogle Scholar
  62. 62.
    Affonso DD, Lovett S, Paul N, et al. A standardized interview that differentiates pregnancy and postpartum symptoms from perinatal clinical depression. Birth 1990; 17: 121–30PubMedCrossRefGoogle Scholar
  63. 63.
    Kitamura T, Shima S, Sugawara M, et al. Psychological and social correlates of the onset of affective disorders among pregnant women. Psychol Med 1993; 23: 967–75PubMedCrossRefGoogle Scholar
  64. 64.
    Pajulo M, Savonlahti E, Sourander A, et al. Antenatal depression, substance dependency and social support. J Affect Disord 2001; 65: 9–17PubMedCrossRefGoogle Scholar
  65. 65.
    Kurki T, Hiilesmaa V, Raitasalo R, et al. Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 2000; 95: 487–90PubMedCrossRefGoogle Scholar
  66. 66.
    Hoffman S, Hatch MC. Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychol 2000; 19: 535–43PubMedCrossRefGoogle Scholar
  67. 67.
    Wu J, Viguera A, Riley L, et al. Mood disturbance in pregnancy and the mode of delivery. Am J Obstet Gynecol 2002; 187: 864–7PubMedCrossRefGoogle Scholar
  68. 68.
    Bolton HL, Hughes PM, Turton P, et al. Incidence and demographic correlates of depressive symptoms during pregnancy in an inner London population. J Psychosom Obstet Gynaecol 1998; 19: 202–9PubMedCrossRefGoogle Scholar
  69. 69.
    Josefsson A, Berg G, Nordin C, et al. Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 2001; 80: 251–5PubMedCrossRefGoogle Scholar
  70. 70.
    Marcus SM, Flynn HA, Blow FC, et al. Depressive symptoms among pregnant women screened in obstetrics settings. J Womens Health 2003; 12: 373–80CrossRefGoogle Scholar
  71. 71.
    Seguin L, Potvin L, St-Denis M, et al. Chronic Stressors, social support, and depression during pregnancy. Obstet Gynecol 1995; 85: 583–9PubMedCrossRefGoogle Scholar
  72. 72.
    Robert E. Treating depression in pregnancy. N Engl J Med 1996; 335: 1056–8PubMedCrossRefGoogle Scholar
  73. 73.
    Andersson L, Sundstrom-Poromaa I, Bixo M, et al. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003; 189: 148–54PubMedCrossRefGoogle Scholar
  74. 74.
    Areias ME, Kumar R, Barros H, et al. Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers. Br J Psychiatry 1996; 169: 30–5PubMedCrossRefGoogle Scholar
  75. 75.
    Birndorf CA, Madden A, Portera L, et al. Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients. Int J Psychiatry Med 2001; 31: 355–65PubMedCrossRefGoogle Scholar
  76. 76.
    Chung TK, Lau TK, Yip AS, et al. Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med 2001; 63: 830–4PubMedGoogle Scholar
  77. 77.
    Da Silva VA, Moraes-Santos Ar, Carvalho MS, et al. Prenatal and postnatal depression among low income Brazilian women. Brazil J Med Biol Res 1998; 31: 799–804CrossRefGoogle Scholar
  78. 78.
    Matthey S, Barnett B, Ungerer J, et al. Paternal and maternal depressed mood during the transition to parenthood. J Affect Dis 2000; 60: 75–85PubMedCrossRefGoogle Scholar
  79. 79.
    O’Heron CA. Coping and postpartum depression: an analysis of coping and depression during pregnancy and the puerperium. [dissertation]. Saint Louis (MO): University of Missouri, 1991Google Scholar
  80. 80.
    Verdoux H, Sutter AL, Glatigny-Dallay E, et al. Obstetrical complications and the development of postpartum depressive symptoms: a prospective survey of the MATQUID cohort. Acta Psychiatr Scand 2002; 106: 212–9PubMedCrossRefGoogle Scholar
  81. 81.
    Zuckerman B, Amaro H, Bauchner H, et al. Depressive symptoms during pregnancy: relationship to poor health behaviours. Am J Obstet Gynecol 1989; 160: 1107–11PubMedGoogle Scholar
  82. 82.
    Depression Research at the National Institute of Mental Health. Fact sheet. Bethesda (MD): NIMH, 2001: NIH publication no. 00-4501. Available at http://www.nimh.nih.gov/publicat/depresfact.cfm Accessed Jan, 2004
  83. 83.
    Spinelli MG. Antepartum and postpartum depression. J Gend Specif Med 1998; 1: 33–6PubMedGoogle Scholar
  84. 84.
    Cefalo RC. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Obstet Gynecol Surv 2002; 57: 68–9CrossRefGoogle Scholar
  85. 85.
    Wisner KL, Gelenberg AJ, Leonard H, et al. Pharmacologic treatment of depression during pregnancy. JAMA 1999; 282: 1264–9PubMedCrossRefGoogle Scholar
  86. 86.
    Lundy B, Field T. Newborns of mothers with depressive symptoms are less expressive. Infant Behav Dev 1996; 19: 419–24CrossRefGoogle Scholar
  87. 87.
    Lundy B, Jones NA, Field T, et al. Prenatal depression effects on neonates. Infant Behav Dev 1999; 22: 119–29CrossRefGoogle Scholar
  88. 88.
    Zuckerman B, Bauchner H, Parker S, et al. Maternal depressive symptoms during pregnancy, and newborn irritability. J Dev Behav Pediatr 1990; 11: 190–4PubMedCrossRefGoogle Scholar
  89. 89.
    Steer RA, Scholl TO, Hediger ML, et al. Self-reported depression and negative pregnancy outcomes. J Clin Epidemiol 1992; 45: 1093–9PubMedCrossRefGoogle Scholar
  90. 90.
    Simon G, VonKorff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry 1995; 52: 850–6PubMedCrossRefGoogle Scholar
  91. 91.
    Bixo M, Sundstrom-Poromaa I, Bjorn I, et al. Patients with psychiatric disorders in gynecologic practice. Am J Obstet Gynecol 2001; 185: 396–402PubMedCrossRefGoogle Scholar
  92. 92.
    US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services. Mental health: a report of the surgeon general. Rockville (MD): NIH, NIMH, 1999Google Scholar
  93. 93.
    Parikh SV, Wasylenki D, Goering P, et al. Mood disorders: rural/urban differences in prevalence, health care utilization, and disability in Ontario. J Affect Disord 1996; 38: 57–65PubMedCrossRefGoogle Scholar
  94. 94.
    Kessler RC, Barber C, Birnbaum HG, et al. Depression in the workplace: effects on short-term disability. Health Aff 2002; 18: 163–71CrossRefGoogle Scholar
  95. 95.
    Goff VV. Depression: a decade of progress, more to do. NHPF Issue Brief 2002; 786: 1–14PubMedGoogle Scholar
  96. 96.
    Spitzer RL, Kroenke K, Linzer M, et al. Health-related quality of life in primary care patients with mental disorders: results from the PRIME-MD Study. JAMA 1995; 274: 1511–7PubMedCrossRefGoogle Scholar
  97. 97.
    Committee to Study the Prevention of Low Birthweight. Eitology and risk factors. Washington (DC): National Academy Press, 1985Google Scholar
  98. 98.
    Kelly RH, Russo J, Holt VL, et al. Psychiatric and substance use disorders as risk factors for low birth weight and preterm delivery. Obstet Gynecol 2002; 100: 297–304PubMedCrossRefGoogle Scholar
  99. 99.
    Nordentoft M, Lou HC, Hansen D, et al. Intrauterine growth retardation and premature delivery: the influence of maternal smoking and psychosocial factors. Am J Public Health 1996; 86: 347–54PubMedCrossRefGoogle Scholar
  100. 100.
    Carter AS, Wood Baker C, Brownell KD. Body mass index, eating attitudes, and symptoms of depression and anxiety in pregnancy and the postpartum period. Psychosom Med 2000; 62: 264–70PubMedGoogle Scholar
  101. 101.
    National High Blood Pressure Education Working Group. National High Blood Pressure Education Working Group report on high blood pressure in pregnancy. Am J Obstet Gynecol 1990; 163: 1689–712Google Scholar
  102. 102.
    MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol 2001; 97: 533–8PubMedCrossRefGoogle Scholar
  103. 103.
    Paarlberg KM, Vingerhoets JJ, Passchier J, et al. Psychosocial factors and pregnancy outcome: a review with emphasis on methodological issues. J Psychosom Res 1995; 39: 563–95PubMedCrossRefGoogle Scholar
  104. 104.
    Einarson A, Koren G. Bacterial vaginosis during pregnancy: should we screen for and treat it? Can Fam Physician 2002; 28: 877–88Google Scholar
  105. 105.
    Zhang J, Klebanoff MA, Levine RJ, et al. The puzzling association between smoking and hypertension during pregnancy. Am J Obstet Gynecol 1999; 181: 1407–13PubMedCrossRefGoogle Scholar
  106. 106.
    Conde-Agudelo A, Althabe F, Belizan JM, et al. Cigarette smoking during pregnancy and risk of preeclampsia: a systematic review. Am J Obstet Gynecol 1999; 181: 1026–35PubMedCrossRefGoogle Scholar
  107. 107.
    Lindqvist PG, Marsal K. Moderate smoking during pregnancy is associated with a reduced risk of preeclampsia. Acta Obstet Gynecol Scand 1999; 78: 693–7PubMedCrossRefGoogle Scholar
  108. 108.
    Vintzileos A, Ananth CV, Smulian CV, et al. The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol 2002; 187: 1254–7PubMedCrossRefGoogle Scholar
  109. 109.
    Vintzileos A, Smulian CV, Scorza WE, et al. The impact of prenatal care on postneonatal deaths in the presence and absence of antenatal high-risk conditions. Am J Obstet Gynecol 2002; 187: 1258–62PubMedCrossRefGoogle Scholar
  110. 110.
    Kogan M, Alexander R, Jack B, et al. The association between adequacy of prenatal care utilization and subsequent pediatric care utilization in the United States. Pediatrics 1988; 102: 25–30CrossRefGoogle Scholar
  111. 111.
    Kelly RH, Danielsen B, Golding J, et al. Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995. Psychiatr Serv 1999; 50: 1584–90PubMedGoogle Scholar
  112. 112.
    Murray J, Bernfield ML. The differential effect of prenatal care on the incidence of low birth weight among blacks and white in a prepaid health care plan. N Engl J Med 1988; 319: 1385–91PubMedCrossRefGoogle Scholar
  113. 113.
    National Institutes of Health. National pregnancy and health survey: drug use among women delivering livebirths. Rockville (MD): 1992. Dept of Health and Human Services, National Institute of Drug Abuse; 1996. NIH publication no. 96-3819Google Scholar
  114. 114.
    Wisbourg K, Kesmodel U, Henriksen TB, et al. A prospective study of smoking during pregnancy and SIDS. Arch Dis Child 2000; 83: 203–6CrossRefGoogle Scholar
  115. 115.
    Mathews TJ, Menacker F, MacDorman MF. Infant mortality statistics from the 2001 period linked birth/infant death data set. Natl Vital Stat Rep 2003; 52: 1–28PubMedGoogle Scholar
  116. 116.
    Centers for Disease Control and Prevention. Alcohol consumption among pregnant women and childbearing-aged women: United States, 1991 and 1995. MMWR 1997; 46: 346–50Google Scholar
  117. 117.
    Serdula M, Williamson DF, Kendrick JS, et al. Trends in alcohol consumption by pregnant women: 1985 through 1988. JAMA 1991; 265: 876–9PubMedCrossRefGoogle Scholar
  118. 118.
    Ebrahmi SH, Luman ET, Floyd RL, et al. Alcohol consumption by pregnant women in the United States during 1988–1995. Obstet Gynecol 1998; 92: 187–92CrossRefGoogle Scholar
  119. 119.
    Health Canada. Canadian perinatal health report, 2000. Ottawa (ON): Minister of Public Works and Government Services Canada, 2000: Cat. No. H49-142/2000EGoogle Scholar
  120. 120.
    Kelly RH, Zatzick DF, Anders TF. The detection and treatment of psychiatric disorders and substance use among pregnant women cared for in obstetrics. Am J Psychiatry 2001; 158: 213–9PubMedCrossRefGoogle Scholar
  121. 121.
    Horrigan TJ, Schroeder AV, Schaffer RM. The triad of substance abuse, violence, and depression are interrelated in pregnancy. J Subst Abuse 2000; 18: 55–8CrossRefGoogle Scholar
  122. 122.
    Polygenis D, Wharton S, Malmberg C, et al. Moderate alcohol consumption during pregnancy and the incidence of fetal malformations: a meta-analysis. Neurotoxicol Teratol 1998; 20: 61–7PubMedCrossRefGoogle Scholar
  123. 123.
    Koren G, Loebstein R, Nulman I. Fetal alcohol syndrome: role of the family physician. Can Fam Physician 1998; 44: 38–40PubMedGoogle Scholar
  124. 124.
    Mattson SN, Schoenfeld AM, Riley EP. Teratogenic effects of alcohol on brain and behavior. Alcohol Res Health 2001; 25: 185–91PubMedGoogle Scholar
  125. 125.
    Autti-Ramo I. Foetal alcohol syndrome: a multifaceted condition. Dev Med Child Neurol 2002; 44: 141–4PubMedCrossRefGoogle Scholar
  126. 126.
    Hard ML, Einarson TR, Koren G. The role of acetaldehyde in pregnancy outcome after prenatal alcohol exposure. Ther Drug Monit 2001; 23: 427–34PubMedCrossRefGoogle Scholar
  127. 127.
    Makarechian N, Agro K, Devlin J, et al. The relationship between moderate alcohol consumption during pregnancy and spontaneous abortion, stillbirth, premature birth and birth weight: a meta-analysis. Can J Clin Pharmacol 1998; 5: 169–76Google Scholar
  128. 128.
    Kandall SR, Gaines J, Habel L, et al. Relationship of maternal substance abuse to subsequent sudden infant death syndrome in offspring. J Pediatr 1993; 23: 120–6Google Scholar
  129. 129.
    Goldstein RB, Mcavay GJ, Nunes EV, et al. Maternal life history: versus gestation-focused assessment of prenatal exposure to substances of abuse. J Subst Abuse 2000; 11: 355–68PubMedCrossRefGoogle Scholar
  130. 130.
    Lepine JP. Epidemiology, burden, and disability in depression and anxiety. J Clin Psychiatry 2001; 62: 4–10PubMedGoogle Scholar
  131. 131.
    Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 2002; 72: 227–36PubMedCrossRefGoogle Scholar
  132. 132.
    Weissman MM, Bland RC, Canino GJ, et al. Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 1999; 29: 9–17PubMedCrossRefGoogle Scholar
  133. 133.
    Einarson A, Selby P, Koren G. Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling. J Psychiatry Neurosci 2001; 26: 44–8PubMedGoogle Scholar
  134. 134.
    Lewis G, Drife J, Botting B, Carson C, Cooper G, Hall M, McCormick C, Neilson J, Oates M, Shaw R, de Swiet M, Millward-Sadler H, Thomas T, Thompson W, Willats S. Why mothers die 1997–1999: the fifth report of the confidential enquiries into maternal deaths in the United Kingdom. London, UK: Royal College of Obstetricians and Gynaecologists Press, 2001Google Scholar
  135. 135.
    Marzuk PM, Tardiff K, Leon AC, et al. Lower risk of suicide during pregnancy. Am J Psychiatry 1997; 154: 122–3PubMedGoogle Scholar
  136. 136.
    Orr ST, James SA, Blackmore Prince C. Maternal prenatal depressive symptoms and spontaneous preterm births among African-American women in Baltimore, Maryland. Am J Epidemiol 2002; 156: 797–802PubMedCrossRefGoogle Scholar
  137. 137.
    Perkin MR, Bland JM, Peacock JL, et al. The effect of anxiety and depression during pregnancy on obstetric complications. Br J Obstet Gynaecol 1993; 100: 629–34PubMedCrossRefGoogle Scholar
  138. 138.
    Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression. Am J Obstet Gynecol 1995; 173: 639–45PubMedCrossRefGoogle Scholar
  139. 139.
    Chaudron LH, Klein MH, Remington P, et al. Predictors, prodromes and incidence of postpartum depression. J Psychosom Obstet Gynaecol 2001; 22: 103–12PubMedCrossRefGoogle Scholar
  140. 140.
    Beck CT. Revision of the postpartum depression predictors inventory. J Obstet Gynecol Neonatal Nurs 2001; 31: 394–402Google Scholar
  141. 141.
    Beck CT. A meta-analysis of predictors of postpartum depression. Nurs Res 1996; 45: 297–303PubMedCrossRefGoogle Scholar
  142. 142.
    O’Hara MW, Swain AM. Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 1996; 8: 37–54CrossRefGoogle Scholar
  143. 143.
    Miller LJ. Postpartum depression. JAMA 2002; 287: 762–5PubMedCrossRefGoogle Scholar
  144. 144.
    Beck CT. Theoretical perspectives of postpartum depression and their treatment implications. MCN Am J Matern Child Nurs 2002; 27: 282–7PubMedCrossRefGoogle Scholar
  145. 145.
    Gitau R, Cameron A, Fisk NM, et al. Fetal exposure to maternal cortisol. Lancet 1998; 352: 707–8PubMedCrossRefGoogle Scholar
  146. 146.
    Allister L, Lester BM, Carr S, et al. The effects of maternal depression on fetal heart rate response to vibroacoustic stimulation. Dev Neuropsychol 2001; 20: 639–51PubMedGoogle Scholar
  147. 147.
    Monk C. Stress and mood disorders during pregnancy: implications for child development. Psychiatr Q 2001; 72: 347–57PubMedCrossRefGoogle Scholar
  148. 148.
    Glover V, O’Connor TG. Effects of antenatal stress and anxiety: implications for development and psychiatry. Br J Psychiatry 2002; 180: 389–91PubMedCrossRefGoogle Scholar
  149. 149.
    Hendrick V, Altshuler L. Management of major depression during pregnancy. Am J Psychiatry 2002; 159: 1667–73PubMedCrossRefGoogle Scholar
  150. 150.
    Coverdale JH, Chervenak FA, Bayer T, et al. Ethically justified clinically comprehensive guidelines for the management of the depressed pregnant patient. Am J Obstet Gynecol 1996; 174: 169–73PubMedCrossRefGoogle Scholar
  151. 151.
    Buist A. Managing depression in pregnancy. Aust Fam Physician 2000; 29: 663–7PubMedGoogle Scholar
  152. 152.
    Casper RC, Fleisher BE, Lee-Ancajas JC, et al. Follow-up of children of depressed mothers exposed or not exposed to antidepressant drugs during pregnancy. J Pediatr 2003; 142: 402–8PubMedCrossRefGoogle Scholar
  153. 153.
    Compendium of Pharmaceuticals and specialties 2002. Ottawa (ON): Canadian Pharmacists Association, 2002Google Scholar
  154. 154.
    Better news on population [noticeboard]. Lancet 2003; 339: 1600Google Scholar
  155. 155.
    Einarson A, Portnoi G, Koren G. Update on Motherisk updates. Can Fam Physician 2002; 48: 1301–4PubMedGoogle Scholar
  156. 156.
    Chambers CD, Johnson KA, Dick LM, et al. Birth outcomes in pregnant women taking fluoxetine. N Engl J Med 1996; 335: 1010–5PubMedCrossRefGoogle Scholar
  157. 157.
    Cohen LS, Heller VL, Bailey JW, et al. Birth outcomes following prenatal exposure to fluoxetine. Biol Psychiatry 2000; 48: 996–1000PubMedCrossRefGoogle Scholar
  158. 158.
    Ericson A, Kallen B, Wilholm BE. Delivery outcome after the use of antidepressants in early pregnancy. Eur J Pharmacol 1999; 55: 503–8CrossRefGoogle Scholar
  159. 159.
    Kulin N, Pastuszak A, Sage S, et al. Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors. JAMA 1998; 279: 609–10PubMedCrossRefGoogle Scholar
  160. 160.
    Mc Connell Linn Filkins. Depression and pregnancy: use of selective serotonin reuptake inhibitors in pregnancy. Prim Care Update Ob Gyns 1998; 5: 11–5CrossRefGoogle Scholar
  161. 161.
    Hendrick V, Smith LM, Suri R, et al. Birth outcomes after prenatal exposure to antidepressant medication. Am J Obstet Gynecol 2003; 188: 812–5PubMedCrossRefGoogle Scholar
  162. 162.
    McElhatton PR, Garbis HM, Elefant E, et al. The outcome of pregnancy in 689 women exposed to therapeutic doses of antidepressants: a collaborative study of the European network of Teratology Information Services (ENTIS). Reprod Toxicol 1996; 10: 285–94PubMedCrossRefGoogle Scholar
  163. 163.
    Addis A, Koren G. Safety of fluoxetine during the first trimester of pregnancy: a meta-analytical review of epidemiological studies. Psychol Med 2000; 30: 89–94PubMedCrossRefGoogle Scholar
  164. 164.
    Misri S, Burgmann A, Kostaras D. Are SSRIs safe for pregnant and breastfeeding women? Can Fam Physician 2000; 46: 626–8PubMedGoogle Scholar
  165. 165.
    Austin MP, Mitchell PB. Psychotropic medications in pregnant women: treatment dilemmas. Med J Aust 1998; 169: 428–31PubMedGoogle Scholar
  166. 166.
    Altshuler LL, Cohen LS, Szuba MP, et al. Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. Am J Psychiatry 1996; 153: 592–606PubMedGoogle Scholar
  167. 167.
    Nulman I, Rovet J, Stewart D, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med 1997; 336: 258–62PubMedCrossRefGoogle Scholar
  168. 168.
    Nulman I, Rovet J, Stewart D, etal. Child development following exposure to tricyclic antidepresants or fluoxetine throughout fetal life: a prospective controlled study. Am J Psychiatry 2002; 159: 1889–95PubMedCrossRefGoogle Scholar
  169. 169.
    Simon GE, Cunningham ML, Davis RL. Outcomes of prenatal antidepressant exposure. Am J Psychiatry 2002; 159: 2055–61PubMedCrossRefGoogle Scholar
  170. 170.
    Mattson S, Eastvold A, Jones K, Harris J, Chambers C. Neurobehavioral follow-up of children prenatally exposed to fluoxetine [abstract]. Teratology 1999; 59: 376Google Scholar
  171. 171.
    Nordeng H, Lindemann R, Perminov KV, et al. Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors. Acta Paediatr 2001; 90: 288–91PubMedCrossRefGoogle Scholar
  172. 172.
    Costei AM, Kozer E, Ho T, et al. Perinatal outcome following third trimester exposure to paroxetine. Arch Pediatr Adolesc Med 2002; 156: 1129–32PubMedCrossRefGoogle Scholar
  173. 173.
    Oberlander TF, Grunau RE, Fitzgerald C, et al. Prolonged prenatal psychotropic medication exposure alters neonatal acute pain response. Pediatr Res 2002; 51: 443–53PubMedCrossRefGoogle Scholar
  174. 174.
    Pastuszak A, Schick-Boschetto B, Zuber C, et al. Pregnancy outcome following first-trimester exposure to fluoxetine (Prozac). JAMA 1993; 369: 2246–8CrossRefGoogle Scholar
  175. 175.
    Koren G. SSRIs in pregnancy: are they safe? Pediatr Res 2002; 51: 424–5PubMedCrossRefGoogle Scholar
  176. 176.
    Doskoch P. Which is more toxic to a fetus: antidepressants or maternal depression [letter]? Neuropsychiatry Rev 2001; 2: 1Google Scholar
  177. 177.
    Thorpe L, Whitney DK, Kutcher SP, et al. Clinical guidelines for the treatment of depressive disorders: VI. Special populations. Can J Psychiatry 2001; 46: 647–768Google Scholar
  178. 178.
    Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry 2003; 160: 555–62PubMedCrossRefGoogle Scholar
  179. 179.
    Tylee A. Depression in Europe: experience from the DEPRES II survey. Eur Neuropsychopharmacol 2000; 10: S445–8PubMedCrossRefGoogle Scholar
  180. 180.
    Sturm R, Wells KB. How can care for depression become more cost-effective? JAMA 1995; 273: 51–8PubMedCrossRefGoogle Scholar
  181. 181.
    Hirschfeld R, Keller M, Panico S, et al. The National Depressive and Manic-Depressive Association consensus statement on the undertreatment of depression. JAMA 1997; 277: 333–40PubMedCrossRefGoogle Scholar
  182. 182.
    Abraham S. Obstetricians and maternal body weight and eating disorders during pregnancy. J Psychosom Obstet Gynaecol 2001; 22: 159–63PubMedCrossRefGoogle Scholar
  183. 183.
    Lyszkiewicz DA, Gerichhausen S, Bjornsdottir I, et al. Evidence based information on drug use during pregnancy: a survey of community pharmacists in three countries. Pharm World Sci 2001; 23: 76–81PubMedCrossRefGoogle Scholar
  184. 184.
    Jasper JD, Goel R, Einarson A, et al. Effects of framing on teratogenic risk perception in pregnant women. Lancet 2001; 358: 1237–8PubMedCrossRefGoogle Scholar
  185. 185.
    Schmidt LA, Greenberg BD, Holzman GB, et al. Treatment of depression by obstetrician-gynecologists: a survey study. Obstet Gynecol 1997; 90: 296–300PubMedCrossRefGoogle Scholar
  186. 186.
    Altshuler LL, Cohen LS, Moline ML, et al. The expert consensus guideline series: treatment of depression in women. Postgrad Med 2001; 1: 1–107Google Scholar
  187. 187.
    Austin MP. Psychosocial assessment and management of depression and anxiety in pregnancy. Aust Fam Physician 2003; 32: 119–26PubMedGoogle Scholar
  188. 188.
    Williams JW, Hitchcock Noel P, Cordes JA, et al. Is this patient clinically depressed? JAMA 2002; 287: 1160–70PubMedCrossRefGoogle Scholar
  189. 189.
    Altshuler LL, Hendrick V, Cohen LS. Course of mood and anxiety disorders during pregnancy and the postpartum period. J Clin Psychiatry 1998; 59: 29–33PubMedGoogle Scholar
  190. 190.
    Dawes M, Chowienczyk PJ. Pharmacokinetics in pregnancy. Best Pract Res Clin Obstet Gynaecol 2001; 15: 819–26PubMedCrossRefGoogle Scholar
  191. 191.
    Hostetter A, Stowe ZN, Strader JR, et al. Dose of selective serotonin uptake inhibitors across pregnancy: clinical implications. Depress Anxiety 2000; 11: 51–7PubMedCrossRefGoogle Scholar
  192. 192.
    Altshuler LL, Hendrick VC. Pregnancy and psychotropic medication: changes in blood levels. J Clin Psychopharmacol 1996; 16: 78–80PubMedCrossRefGoogle Scholar
  193. 193.
    Wisner KL, Perel JM, Wheeler SB. Tricyclic dosage requirements across pregnancy. Am J Psychiatry 1993; 150: 1541–2PubMedGoogle Scholar
  194. 194.
    Heikkinen T, Ekblad U, Kero P, et al. Citalopram in pregnancy and lactation. Clin Pharmacol Ther 2002; 72: 184–91PubMedCrossRefGoogle Scholar
  195. 195.
    Einarson A, Miropolsky V, Varma B, et al. Determinants of physicians’ decision-making regarding the prescribing of antidepressant medication during pregnancy [abstract]. Fifteenth International Conference of the Organization of Teratology Information Services (OTIS); 2002 Jun 22–25; Arizona. Teratology 2002; 65: 369–70Google Scholar
  196. 196.
    Einarson A, Selby P, Koren G. Discontinuing antidepressants and benzodiazepines upon becoming pregnant. Can Fam Physician 2001; 47: 457–672Google Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Heather A. Bennett
    • 1
  • Adrienne Einarson
    • 2
  • Anna Taddio
    • 3
  • Gideon Koren
    • 2
    • 4
  • Thomas R. Einarson
    • 1
    • 2
  1. 1.Faculty of PharmacyUniversity of TorontoTorontoCanada
  2. 2.The Motherisk ProgramThe Hospital for Sick ChildrenTorontoCanada
  3. 3.Department of PharmacyThe Hospital for Sick ChildrenTorontoCanada
  4. 4.Department of Medicine, Faculty of PharmacologyUniversity of TorontoTorontoCanada

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