SAN DIEGO— Although an antidepressant may have an effect on a fetus in utero, so too may the maternal risk of depression. Babies born to women who were at risk for depression were born at an earlier gestational age and had elevated stress hormone levels, according to a study reported at the 53rd Annual Meeting of the American Academy of Child and Adolescent Psychiatry.

"The question is, Does bathing an infant in an intrauterine environment where the mother’s stress hormones are high affect the baby?" asked Sheila M. Marcus, MD, Clinical Associate Professor of Psychiatry at the University of Michigan in Ann Arbor.

Previous evidence has suggested that SSRIs may have a negative prenatal impact. However, that debate is still open, and little research has been done regarding the effect of depression risk on neonatal outcomes, Dr. Marcus and colleagues pointed out. The findings in this study are unique because they report on a group of women who are at high risk for major depressive disorder. For the study, led by principal investigator Delia Vazquez, MD, women were defined as high risk by having a history of major depression or an Edinburgh Postnatal Depression Scale (EPDS) score greater than 10.

The investigators reported preliminary findings on 53 infant-mother pairs from 135 pregnant women. Maternal plasma cortisol as well as other stress hormone levels were measured throughout pregnancy. Infant cord blood was examined for adrenocorticotropic hormone and cortisol levels, and salivary cortisol level was measured for the first seven months postbirth.

The researchers found that infants born to women at risk for major depression were born significantly earlier. Mean gestational ages were 35.6 weeks for infants born to women who were at risk for major depressive disorder and who developed major depressive disorder later in the pregnancy—38.6 weeks for infants of women with a high risk of depression (history of depression or EPDS score greater than 10) and 39.4 weeks for those born to women at low risk of depression (no history of depression and EPDS score less than 10). Motor maturity tended to be lower and cortisol levels higher in the infants with mothers at risk for depression, but the differences were not significant, noted Dr. Marcus.

Women who later developed major depressive disorder, as well as those at high risk for the disorder but who did not develop it during pregnancy, had significantly higher cortisol and adrenocorticotropic hormone levels compared with low-risk women. Cord blood of babies born to mothers at high risk for depression tended to have more cortisol, but the trend did not reach significance in the relatively small group analyzed, reported the researchers. In addition, babies born to at-risk women were seen to be more lethargic when they were evaluated at two weeks per a neurobehavioral scale that rates developmental and behavioral maturation, CNS integrity, and stress responses.

The infants of women at high risk for depression were found to have poorer quality of movement (-0.36 versus -0.26 for infants of women with a low risk of depression); greater levels of hypotonia (0.49 versus -0.22 for infants of women at low risk); and higher stress scores (0.56 versus 0.13 for infants of women at low risk). "These findings may indicate altered neurologic development," said Dr. Marcus.

The researchers cautioned that their results are preliminary, but they believe that the study "may improve our understanding of the early genesis of mood disorders."

Suggested Reading
Austin MP. To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects. Psychol Med. 2006; 25:1-8.
Lattimore KA, Donn SM, Kaciroti N, et al. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: a meta-analysis. J Perinatol. 2005;25:595-604.
Oberlander TF, Warburton W, Misri S, et al. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry. 2006;63:898-906.
Young EA, Vazquez D, Jiang H, Pfeffer CR. Saliva cortisol and response to dexamethasone in children of depressed parents. Biol Psychiatry. 2006;60:831-836.

Return to table of contents