Pregnant question

In the past decade there has been a flurry of research into the effects of antidepressants on pregnancy - in particular, on selective seratonin reuptake inhibitors (SSRIs), which include Prozac and are the most commonly prescribed such drugs. So far, findings published on their possible effects have been all over the map - from increased likelihood of pre-term delivery to poor adaptation by newborns because of withdrawal symptoms from the drugs.

This month, a report in the Archives of General Psychiatry by Kaiser Permanente researchers suggested that pregnant women who use SSRIs might increase their likelihood of having a child with an autism spectrum disorder (autism, Asperger’s syndrome, or other unspecified pervasive developmental disorders). Released in conjunction with a landmark study reporting that environmental factors may play a much larger role in autism than previously thought, the findings on antidepressants have fueled the debate over whether SSRIs can be harmful during pregnancy. (Some of the same researchers participated in both studies.)

Between 14 percent and 23 percent of women experience a depressive disorder while pregnant, according to a 2009 report by the American Psychiatric Association and the American College of Obstetricians and Gynecologists. The numbers are similar to those for women in the general population. Left untreated in pregnant women, depression has been shown to lead to such problems as poor fetal development and mother-infant bonding, and pre-term delivery.

What’s an expectant mother to do? How does she make a decision about whether it’s safe to use antidepressants when she’s suffering from a disorder that makes her more anxious to begin with?

“In pregnancy in general, we tend to be afraid of all medicine,’’ said Dr. Lori Wroble, the chief obstetrician for Harvard Vanguard Medical Associates at Newton-Wellesley Hospital. “And I think it’s actually scarier when you don’t have enough studies, because it’s an open-ended question that you’ll always wonder about.’’