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Asdf Essay

2047 words - 9 pages

It has been demonstrated that serotonin increases chorionic vein and umbilical artery vasoconstriction, leading to reduced placental blood circulation, a major underlying factor in the development of preeclampsia (Palmsten et al., 2012). In assessing the effects of SSRIs on the prevalence of preeclampsia, it is particularly important to control for maternal depression, as there is a well-documented connection between the two (Reis and Källén, 2010; Toh et al., 2009). De Vera et al. (2012) found a 53% increased risk of pregnancy-induced hypertension associated with intrauterine antidepressant use, independent of maternal age or depression symptoms. Other studies have found important connections between the timing of SSRI exposure and preeclampsia (De Vera et al., 2012). Palmsten et al. (2011) found that women with depression diagnoses and antidepressant dispensings between gestational weeks 10 and 20 were at particular risk for preeclampsia. Toh et al. (2009) reported that the risk for preeclampsia among women who continued SSRI treatment after the first trimester was 15.2% while the risk for women who discontinued treatment before the end of the first trimester was only 3.7%. The same researchers also found that the risk of preeclampsia in women who were not treated with SSRIs (2.4%) was comparable to the risks in women who discontinued their treatment.

Postpartum hemorrhage is another important risk for mothers, but the increased risk with SSRIs is more poorly characterized than that of preeclampsia (Palmsten et al., 2013). Postpartum hemorrhage is the leading cause of maternal morbidity worldwide, and incidence in the US has increased since the 1990’s (Palmsten et al., 2013). It has been proposed that because serotonin contributes to platelet aggregation, SSRIs may inhibit serotonin uptake by platelet-induced clotting reduction (Palmsten et al., 2013). Palmsten et al. (2013) found that the use of SSRIs at the time of delivery was associated with a 1.4-1.5 fold increase in risk of postpartum hemorrhage compared to women with diagnosed, but untreated depression. Researchers also characterized the relative risk associated with particular time points of SSRI use during pregnancy by examining prescription records. They found that when antidepressants were discontinued between one and five months before the delivery date there was no significant increased risk associated with SSRI use.

When discussing the risks and benefits of pharmacologic therapies for perinatal depression, it is important to maintain perspective. While the above data suggest that intrauterine treatment with SSRIs is accompanied by increased risks of many negative outcomes of varying severity, the risk must be weighed against the benefits. Every clinical presentation of perinatal depression is unique and requires special considerations. But severe perinatal depression should almost universally be treated pharmacologically (Byatt et al., 2013). The risks to both the mother and...

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