New Study Causes Controversy over Anti-Depressants during Pregnancy

A new study reviews the existing research on the use during pregnancy of Selective Serotonin Reuptake Inhibitors (SSRI), the most common type of anti-depressants, on women with fertility issues. The researchers say their findings confirm that:

“antidepressant use during pregnancy is associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects.” 

The author’s more controversial suggestion, however, is that: “There is no evidence of improved pregnancy outcomes with antidepressant use.”

While the current consensus among obstetricians and mental health experts is that depression itself is bad for both a mother and a developing embryo or fetus, and that continuing medication can be the healthiest choice, the authors of this review strongly disagree. They say there is no evidence that depression itself is bad for pregnancy or that SSRIs are good. Dr. Alice Domar, executive director of the Domar Center for Mind/Body Health at Boston IVF and one of the authors argued:

“There is really no conclusive evidence that SSRIs are better than placebo. I don’t want women to stay on this medication thinking it’s as safe as a sugar pill because it’s not.”

Domar and her co-authors say that many women on SSRIs are only mildly depressed and suggest that they should rely on talk therapy, especially cognitive behavior therapy, instead. 

Many experts disagree and say these suggestions could be dangerous to depressed mothers-to-be. Gregory Moore, director of health services at Georgia Tech in Atlanta and a member of the American College of Obstetricians and Gynecologists’ (ACOG) committee on ethics said: “I would say the authors of this article went overboard in terms of their negativity. Depression can be a fatal disease.” Other experts remind us that depressed mothers may forget to eat or be unable to sleep which has negative implications for the fetus. Dr. Kimberly Yonkers, a mental health expert at Yale University, agrees that some women with mild depression may be able to wean themselves off of medication during pregnancy but warns:

“It’s a dangerous message for women who are pregnant and depressed to say that antidepressants don’t benefit them. To take someone who is stable (on medications) and tell them they shouldn’t take it because of all the harm is ridiculous.”

Women Who Are Stressed or Depressed Don’t Use Birth Control Consistently

An unrelated piece of research that is being presented at this week’s American Public Health Association annual meeting, suggests that depression and stress may interfere with correct and consistent use of birth control. Researchers followed 689 non-pregnant Michigan women ages 18 and 19 for a year. Participants answered questions about their mental health and filled out a weekly journal about their sexual behavior and contraceptive use. About 25 percent of women had moderate to severe depression, and 25 percent had moderate to severe stress.

Participants in the study used contraception (mostly the pill and condoms) consistently about 72 percent of the time. The researchers found that women with depression were 47 percent less likely to use contraception consistently each week than their peers with less severe symptoms. Similarly, women who were stressed were 69 percent less likely to use contraception consistently.      

Though the research doesn’t specifically explain why these differences exist, one of the authors suggests that mental health issues may impair a woman’s decision-making ability or that the depression may be caused by other issues in their life such as unemployment that get in the way of using contraception effectively. 

The researchers fear that unintended pregnancy could make these women’s situations worse and suggest that women who are depressed or highly stressed might be good candidates for long-acting reversible contraceptive methods (such as implants and IUDs) that are highly effective but do not require users to take any action every day or even every time they have sex. 

Girls with Low Literacy More Likely to Give Birth as Teens

A new study also being released at the American Public Health Association’s annual meeting looks at how literacy levels impact teen pregnancy. The study out of the University of Pennsylvania School of Nursing compared the reading scores and birth records of over 12,000 girls enrolled in the Philadelphia public schools between 1996 and 2002. The study found that “girls who had below-average reading skills were 2.5 times more likely to bear a child during their teen years as compared to preteens who had average reading skills.”  Specifically, 21 percent of girls with below-average reading levels had one live birth during the six-year examination period, while three percent of girls with below-average reading levels had two or more live births within that period. Only 12 percent of girls with average reading skills had one live birth and only one percent had two or more live births. In contrast, of the girls with above-average reading skills, 5 percent had one live birth and only 0.4 percent had two or more live births.

The study also found that a higher percentage of African-American and Hispanic girls had below-average reading skills and that the impact of low literacy on teen birth was greater in Hispanic and African-American girls than those who identified themselves as white. Dr. Rosemary Frasso, one of the researchers on the study, gives this explanation for the connection between race, literacy, and early childbirth:

“It is quite possible that adolescent girls who experience a daily sense of rejection in the classroom might feel as though they have little chance of achievement later on in life. Our findings underscore the role of literacy as its own social risk factor throughout the life-course.”

Reading ability is not something parents and pre-teens usually discuss with their health care provider, but Frasso believes that this should change.  She feels that it is important for doctors to help their preteen girl patients get connected with literacy it programs.  Frasso explains:

“Public health and healthcare providers and policy makers should recognize the very strong link between early education and teen childbearing when considering interventions to reduce this outcome. More collaboration between educators and healthcare providers would also be a good idea.”