Depression is relatively common during pregnancy, affecting 10% to 15% of all women. Over the last decade, information has accumulated regarding the use of fluoxetine, the tricyclic antidepressants, and some of the newer selective serotonin reuptake inhibitors, including citalopram. Less information has been available regarding some of the other classes of antidepressants; consequently, these agents have been used less commonly during pregnancy.
In a recent prospective study from Einarson and colleagues, 147 women taking either nefazodone (n=89) or trazodone (n-58) were enrolled during their first trimester of pregnancy. Compared to two control groups of women exposed to either non-teratogenic drugs (n = 147) or to other antidepressants (n=147), there were no significant differences among exposed and non-exposed groups with regard to several outcomes of interest, including rates of congenital malformations, rates of spontaneous abortions, rates of premature labor, and birth weight.
These preliminary results suggest that there is no increase in risk of congenital malformations among infants exposed to either nefazodone or trazodone. While these data are reassuring, it should be noted that, in order to detect a two-fold increase in the prevalence of a given malformation, it is necessary to collect at least 400 to 600 exposures. Thus, further studies are required.
Ruta Nonacs, M.D., Ph.D.
