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Medication in Pregnancy Considering Risks of Medication in Pregnancy Vivien Burt, MD, PhD The Women’s Life Center Resnick Neuropsychiatric Hospital at UCLA

Risks of Medication in Pregnancy Birth defects Miscarriage Fetal health at delivery Growth impairment Preterm delivery Long-term impact

The Impact of Antidepressants in Pregnancy on Infant Outcome Effect on infant outcome and maternal illness Indication Effect on infant outcome Confounded by Poor/imperfect data collection Ascertainment bias Nonrandom sampling

Studies are Uncontrolled for Associated Behaviors Smoking Poor nutrition Drinking Poor hygiene Use of nonprescribed and undisclosed medications Drugs Noncompliance with perinatal visits and directions

Small Studies Problems with subgroup analyses Larger group of SSRI-exposed pregnancies Making conclusions, then teasing apart effects of various SSRI antidepressants Conclusions not statistically valid

Communicating with Patients Present the information simply Patients get information that is often alarming and inaccurate Distinguish risks in the context of pregnant patients

Key Points No study is perfect. Background risk for congenital anomaly are 2% to 4%. Review what is known about each of the risks: Teratogenicity or congenital defects Miscarriage Neonatal difficulties at birth or delivery Fetal growth impairment Long-term developmental concerns

Next Presentation Reviewing the Literature: Teratogenicity