My sister, who is pregnant, has a history of depression. I’m concerned because I recently heard about a study indicating that depressed women have smaller birth-weight babies, which can lead to developmental delays. Is this true? Is it the depression, the medication or something else that causes the low birth weight?

Ten percent of pregnant women will experience clinical depression, and when they do it is important to address the depression from an informed position. Doctors have known for many years that maternal depression during a young infant’s life can adversely effect that child for months and even years. Recent research demonstrates that untreated maternal depression during pregnancy can also have negative effects on the growing fetus. These include low birth weight, failure to develop at a normal pace, poor attachment and even behavioral and learning problems years later. Because of these possible negative effects on the child, as well as the effects on the mother, it is important to treat clinical depression in pregnancy. If the depression is mild and/or can be quickly ameliorated with psychotherapy, talk therapy is an excellent option. Often though, medications are necessary. While no antidepressant is 100% safe, psychiatrists are gaining significant knowledge about these medications, as more studies are done. Literally thousands of babies have been exposed to various medications during the mother’s pregnancy. An informed decision is made in concert with the parents, the Ob/Gyn and a psychiatrist. Now that we realize there are untoward effects of depression on the developing baby, that needs to be accounted for in weighing the risks and benefits of any potential treatment.

Elizabeth F. Pribor, MD
Associate Professor of Clinical Psychiatry
Washington University School of Medicine

Depression is extremely common in women. Pregnancy can often exacerbate underlying depression. There are good data that suggest women with depression are at risk of delivering low birth weight infants. This most likely is not a result of the depression (bio-chemical imbalance) itself. More likely, depression can lead to behaviors that cause low birth weight. Some of these behaviors include substance abuse and malnutrition. Also, patients with depression are less likely to take vitamins routinely, go to pre-natal visits and eat a balanced diet. Anti-depressants, especially the newer SSRI class of medicines, are mostly category C types of drugs, and these have not been linked thus far to poor outcomes.

Michael Chen, MD
Clayton Heights Ob-Gyn
St. Louis, MO

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