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Major depressive disorder during pregnancy: Psychiatric medications have minimal effects on the fetus and infant yet development is compromised

  • Hanna C. Gustafsson (a1), Sherryl H. Goodman (a2), Tianshu Feng (a3), Jean Choi (a3), Seonjoo Lee (a3) (a4), D. Jeffrey Newport (a5), Bettina Knight (a6), Blaire Pingeton (a4), Zachary N. Stowe (a7) and Catherine Monk (a3) (a4)...


Psychotropic medication use and psychiatric symptoms during pregnancy each are associated with adverse neurodevelopmental outcomes in offspring. Commonly, studies considering medication effects do not adequately assess symptoms, nor evaluate children when the effects are believed to occur, the fetal period. This study examined maternal serotonin reuptake inhibitor and polypharmacy use in relation to serial assessments of five indices of fetal neurobehavior and Bayley Scales of Infant Development at 12 months in N = 161 socioeconomically advantaged, non-Hispanic White women with a shared risk phenotype, diagnosed major depressive disorder. On average fetuses showed the expected development over gestation. In contrast, infant average Bayley psychomotor and mental development scores were low (M = 84.10 and M = 89.92, range of normal limits 85–114) with rates of delay more than 2–3 times what would be expected based on this measure's normative data. Controlling for prenatal and postnatal depressive symptoms, prenatal medication effects on neurobehavioral development were largely undetected in the fetus and infant. Mental health care directed primarily at symptoms may not address the additional psychosocial needs of women parenting infants. Speculatively, prenatal serotonin reuptake inhibitor exposure may act as a plasticity rather than risk factor, potentially enhancing receptivity to a nonoptimal postnatal environment in some mother–infant dyads.

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Corresponding author

Address correspondence and reprint requests to: Catherine Monk, Behavioral Medicine/CUMC, 622 West 168th St. PH1540, New York, NY 10032; E-mail:


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The authors gratefully acknowledge the women who participated in this study and the community obstetrical practices in the Atlanta area for their assistance. This study was supported by the Translational Research Center in Behavioral Sciences (TRCBS) Grant P50 MH077928. Research reported in this publication was also supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR002371. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.



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