Editing Antidepressant (section)

===Pregnancy===
SSRI use in pregnancy has been associated with a variety of risks with varying degrees of proof of causation. As depression is independently associated with negative pregnancy outcomes, determining the extent to which observed associations between antidepressant use and specific adverse outcomes reflect a causative relationship has been difficult in some cases.<ref>{{cite journal|author=Malm H|s2cid=22875385|title=Prenatal exposure to selective serotonin reuptake inhibitors and infant outcome|journal=Ther Drug Monit|volume=34|issue=6|pages=607–14|date=December 2012|pmid=23042258|doi=10.1097/FTD.0b013e31826d07ea}}</ref> In other cases, the attribution of adverse outcomes to antidepressant exposure seems fairly clear.

SSRI use in pregnancy is associated with an increased risk of spontaneous abortion of about 1.7-fold,<ref>{{cite journal|vauthors=Rahimi R, Nikfar S, Abdollahi M|title=Pregnancy outcomes following exposure to serotonin reuptake inhibitors: a meta-analysis of clinical trials|journal=Reproductive Toxicology|volume=22|issue=4|pages=571–575|year=2006|pmid=16720091|doi=10.1016/j.reprotox.2006.03.019|bibcode=2006RepTx..22..571R }}</ref><ref name="pmid23351929">{{cite journal|vauthors=Nikfar S, Rahimi R, Hendoiee N, Abdollahi M|title=Increasing the risk of spontaneous abortion and major malformations in newborns following use of serotonin reuptake inhibitors during pregnancy: A systematic review and updated meta-analysis|journal=DARU Journal of Pharmaceutical Sciences|volume=20|issue=1|pages=75|year=2012|pmid=23351929|pmc=3556001|doi=10.1186/2008-2231-20-75|doi-access=free}}</ref> and is associated with preterm birth and low birth weight.<ref>{{cite journal|vauthors=Huang H, Coleman S, Bridge JA, Yonkers K, Katon W|title=A meta-analysis of the relationship between antidepressant use in pregnancy and the risk of preterm birth and low birth weight|journal=General Hospital Psychiatry|volume=36|issue=1|pages=13–8|year=2014|pmid=24094568|pmc=3877723|doi=10.1016/j.genhosppsych.2013.08.002}}</ref>

A systematic review of the risk of major birth defects in antidepressant-exposed pregnancies found a small increase (3% to 24%) in the risk of major malformations and a risk of cardiovascular birth defects that did not differ from non-exposed pregnancies.<ref>{{cite journal|vauthors=Einarson TR, Kennedy D, Einarson A|title=Do findings differ across research design? The case of antidepressant use in pregnancy and malformations|journal=J Popul Ther Clin Pharmacol|volume=19|issue=2|pages=e334–48|year=2012|pmid=22946124|url=https://jptcp.com/index.php/jptcp/article/view/428}}</ref> A study of fluoxetine-exposed pregnancies found a 12% increase in the risk of major malformations that did not reach statistical significance.<ref>{{cite journal|vauthors=Riggin L, Frankel Z, Moretti M, Pupco A, Koren G|title=The fetal safety of fluoxetine: a systematic review and meta-analysis|journal=J Obstet Gynaecol Can|volume=35|issue=4|pages=362–9|date=April 2013|pmid=23660045|doi=10.1016/S1701-2163(15)30965-8|doi-access=free}}</ref> Other studies have found an increased risk of cardiovascular birth defects among depressed mothers not undergoing SSRI treatment, suggesting the possibility of ascertainment bias, e.g. that worried mothers may pursue more aggressive testing of their infants.<ref>{{cite journal|vauthors=Koren G, Nordeng HM|title=Selective serotonin reuptake inhibitors and malformations: case closed?|journal=Semin Fetal Neonatal Med|volume=18|issue=1|pages=19–22|date=February 2013|pmid=23228547|doi=10.1016/j.siny.2012.10.004}}</ref> Another study found no increase in cardiovascular birth defects and a 27% increased risk of major malformations in SSRI exposed pregnancies.<ref name=pmid23351929/> The FDA advises for the risk of birth defects with the use of paroxetine<ref>{{cite press release|publisher=U.S. Food and Drug Administration|title=FDA Advising of Risk of Birth Defects with Paxil|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108527.htm|access-date=29 November 2012|archive-url=https://web.archive.org/web/20131203022919/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108527.htm|archive-date=3 December 2013}}</ref> and the MAOI should be avoided.

A 2013 systematic review and meta-analysis found that antidepressant use during pregnancy was statistically significantly associated with some pregnancy outcomes, such as gestational age and preterm birth, but not with other outcomes. The same review cautioned that because differences between the exposed and unexposed groups were small, it was doubtful whether they were clinically significant.<ref>{{cite journal|vauthors=Ross LE, Grigoriadis S, Mamisashvili L, Vonderporten EH, Roerecke M, Rehm J, Dennis CL, Koren G, Steiner M, Mousmanis P, Cheung A|title=Selected pregnancy and delivery outcomes after exposure to antidepressant medication: a systematic review and meta-analysis|journal=JAMA Psychiatry|volume=70|issue=4|pages=436–443|date=April 2013|pmid=23446732|doi=10.1001/jamapsychiatry.2013.684|s2cid=2065578}}</ref>

A [[neonate]] (infant less than 28&nbsp;days old) may experience a [[withdrawal syndrome]] from abrupt discontinuation of the antidepressant at birth. Antidepressants can be present in varying amounts in breast milk, but their effects on infants are currently unknown.<ref>{{cite journal|vauthors=Lanza di Scalea T, Wisner KL|title=Antidepressant Medication Use During Breastfeeding|journal=Clinical Obstetrics and Gynecology|volume=52|issue=3|pages=483–97|year=2009|pmid=19661763|pmc=2902256|doi=10.1097/GRF.0b013e3181b52bd6}}</ref>

Moreover, SSRIs inhibit nitric oxide synthesis, which plays an important role in setting the vascular tone. Several studies have pointed to an increased risk of prematurity associated with SSRI use, and this association may be due to an increased risk of [[pre-eclampsia]] during pregnancy.<ref>{{cite journal|vauthors=Sivagnanam G|title=Antidepressants|journal=Journal of Pharmacology and Pharmacotherapeutics|year=2012|volume=3|issue=3|pages=287–288|doi=10.1177/0976500X20120302|s2cid=248110770|id={{ProQuest|1033762996}}|url=http://www.jpharmacol.com/text.asp?2012%2F3%2F3%2F287%2F99452|access-date=21 March 2013|archive-date=1 July 2018|archive-url=https://web.archive.org/web/20180701165032/http://www.jpharmacol.com/text.asp?2012%2F3%2F3%2F287%2F99452|url-status=dead}}</ref>