A new study discussed at the American Academy of Child and Adolescent Psychiatry meeting (Marcus SM, et al “Perinatal Depression: Neuroendocrine and Behavioral Impacts on the Neonate” AACAP 2006; 33:A16) provides additional support for treatment of depression during pregnancy. As reported, untreated major depressive disorder during pregnancy was associated with significant changes in neurobehavioral function, earlier deliveries and elevated stress hormones.
“The question is, does bathing an infant in an intrauterine environment where the mother’s stress hormones are high affect thebaby? “said Sheila M. Marcus, M.D., of the University of Michigan in Ann Arbor. Whilesome evidence has suggested that the medications used to treat depression,such as selective serotonin reuptake inhibitors (SSRIs),may have a negative prenatal impact, the issue is still unclearand little study has been done on the effect of untreated depression during pregnancy,Dr.Marcus and and colleagues said.
Some of the findings, although preliminary, are as follows:
Mean gestational ages were:
– 35.6 weeks for infants born to women with major depressive disorder.
– 38.6 weeks for those of women with high risk of depression (past history of depression or Edinburgh Postnatal Depression Scale likelihood ratio greater than 10).
– 39.4 weeks for those born to women at low risk of depression (no past history of depression and Edinburgh Postnatal Depression Scale likelihood ratio less than 10).
Motor maturity tended to be lower and cortisol levels were higher in infants with depressed mothers but the differences were not found to be significant.
The findings for infants of high risk women were:
– Poorer quality of movement (-0.36 versus -0.26 low risk, P=0.07)
– More hypotonia (0.49 versus -0.22 low risk, P>0.01)
– Higher stress scores (0.56 versus 0.13 low risk, P>0.003)
Weighing the risks of intrauterine fetal exposure against the risks of untreated depression has been the object of study and research for some time. For those of us who confront mothers seeking treatment options, it is a delicate balance that must take into account a number of factors: severity of depressive episode, history of depression, degree of impairment, coping capacity, available support network. And as is true with all of the work we do, each decision must be made on an individual case-by-case basis.