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

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

4. 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

5. 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

6. 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

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

8. 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

9. Next Presentation Reviewing the Literature: Teratogenicity