Pregnancy complications

• Pregnancy complications may need special medical care.
• Common problems include anemia, diabetes and bleeding.
• Ask your provider about the signs of serious complications.

share |e-mail |print

As many as 1 out of 5 women have symptoms of depression during pregnancy. For some women, those symptoms are severe. In pregnancy, women who have been depressed before are at higher risk of depression than other women.

Depression is a serious medical condition. It poses risks for the woman and her baby. But a range of treatments are available. These include therapy, support groups and medications.

It is usually best for a team of health care professionals to work with a pregnant woman who is depressed or who has a history of depression. Team members include:

• The provider who is caring for her during her pregnancy
• A mental health professional
• The provider who will take care of the baby after birth

Together, the team and the woman decide what is best for her and her baby.

Often a pregnant woman wonders whether antidepressant drugs, such as Zoloft and Prozac, will harm her baby or herself. There are no simple answers. Each woman and her health care providers must work together to make the best decision for her and her baby. The drugs used to treat depression have both risks and benefits.

IMPORTANT: If you are taking an antidepressant and find that you are pregnant, do not stop taking your medication without first talking to your health provider. Call him or her as soon as you discover that you are expecting. It may be unhealthy to stop taking an antidepressant suddenly.

What is depression?
Depression is an illness that involves the body, mood and thought. It affects the way a woman feels about herself and the way she thinks about things. This article addresses two types of depression:

Major depression is a serious illness that interferes with a person's ability to work, study, sleep, eat and enjoy oneself. It may appear once in a person's life, but more often occurs several times.

Milder forms of depression are less severe. Persons may still have long-term symptoms. They are able to conduct day-to-day activities, but they don't always function well or feel good. They may also have episodes of major depression.

The risks of untreated depression during pregnancy
Depression, especially if it isn't treated, carries serious risks for the pregnant woman and her baby. These risks include:

• Poor prenatal care
• Preeclampsia, a type of high blood pressure that occurs during pregnancy
• Poor weight gain
• Unhealthy eating habits
• Use of drugs or alcohol to self-medicate
• Suicide

Depressed mothers are often less able to care for themselves or their children, or to bond with their children.

Babies born to women with depression may be more irritable, less active and less attentive than other babies. They may also be born prematurely or have low birthweight.

What are the symptoms of depression?
A woman who is depressed feels sad or "blue" and has other symptoms that last for 2 weeks or longer. The other symptoms include the following:

• Trouble sleeping
• Sleeping too much
• Lack of interest
• Feelings of guilt
• Loss of energy
• Difficulty concentrating
• Changes in appetite
• Restlessness, agitation or slowed movement
• Thoughts or ideas about suicide

It may be hard to diagnose depression during pregnancy. Some of its symptoms are similar to those normally found in pregnancy. For instance, changes in appetite and trouble sleeping are common when a woman is pregnant. Other medical conditions have symptoms similar to those for depression. For instance, a woman who has anemia or a thyroid problem may lack energy but not be depressed.If you have any of the symptoms listed, talk to your health care provider. He or she will check to see what might be causing your symptoms.

Treatment without medication
Depression can be treated in several ways. Support groups may help. Some women go to therapy or counseling with a mental health professional (such as a social worker, psychotherapist or psychiatrist). For women with mild foms of depression, individual or group therapy may be all the treatment they need.

Some people suffer from a type of depression that comes on during the fall or winter, when there is less sunlight. This is called seasonal affective disorder (SAD). This condition is treated with light therapy. In her home, the patient looks into a box with special light bulbs. The health provider recommends how many times a day and for how long the patient needs to use the light box.

Another form of treatment is electroconvulsive therapy (ECT). During this treatment, electric current is passed through the brain. ECT may be recommended in cases of severe depression.

Medication: Antidepressants
Most antidepressants can be categorized into one of two groups. (Use of trade names is for identification only and does not imply endorsement.)

Group 1: Selective serotonin uptake inhibitors (SSRIs). This group of drugs includes:

• Prozac (fluoxetine)
• Lexapro (escitalopram)
• Zoloft (sertraline)
• Celexa (citalopram)
• Effexor (venlafaxine)
• Paxil (paroxetine)
• Cymbalta (duloxetine)

Group 2: Tricyclic antidepressants (TCAs). This group of drugs includes:

• Elavil (amitriptyline)
• Tofranil (imipramine)
• Pamelor (Aventyl, nortriptyline)

If a woman is taking an antidepressant and wants to get pregnant, she should talk to her health care provider beforehand. Together, they will decide whether she should keep taking the medication, change the medication, gradually reduce the dose or stop taking it.

What research tells us about antidepressants
It's challenging to study and understand the risks of any drug given to pregnant women. During pregnancy, two patients—the mother and the fetus—are exposed to the drug. Medications that are safe for a woman are sometimes risky for a fetus. Because of this, researchers have not studied many drugs during pregnancy. Here is what we know from research. 

Several drugs have been used for many years without any obvious signs of serious risk to the baby. For instance, TCAs have been around for many years, so we have more information about them than about SSRIs. SSRIs are a newer group of drugs than TCAs. Researchers are continuing to study them.

Some antidepressants, but not all, have been linked to problems for the baby. Examples include heart problems, low birthweight, and high blood pressure in the arteries that supply blood to the lungs (pulmonary hypertension).

Women who are depressed are very likely to become ill again if they stop taking their medications.

Some women benefit from a combination of therapy and antidepressants.

Choosing an antidepressant
This decision is difficult because we don't know all the answers. No drug is entirely safe. A woman and her health care team must look at her case and carefully weigh:

• The risks and benefits of various drugs
• The risks and benefits of other types of treatment
• The risk of untreated depression for the woman and her baby

St. John's wort and other herbal remedies
St. John's wort is an herb that some people use to treat depression. According to the National Center for Complementary and Alternative Medicine, some research has shown that St. John's wort may be useful for treating mild to moderate depression. Other studies have shown that it is does not help one type of major depression.

Herbal products, such as St. John's wort, vary in strength and quality from product to product. We need more research to help us know whether St. John's wort is useful and safe for treating depression in pregnant women.

IMPORTANT: We know very little about the effect of St. John's wort on the fetus. Do no take this herb or other herbal remedies without first speaking to your health provider.

Resources
The Organization of Teratology Information Services (OTIS), (866) 626-6847. Provides fact sheets on pregnancy and specific antidepressants, including Prozac and Zoloft.

Depression During and After Pregnancy, a resource for women, their families and friends, provided by the U.S. Department of Health and Human Services.

Depression During and After Pregnancy, provided by the Maternal and Child Health Library.

September 2009