In the meantime, Holzman would prefer that the drugs not be given at the end of the third trimester in anticipation of a condition such as postpartum depression. "I wouldn't want to expose a baby for a non-problem which may or may not occur," he said.
Lusskin disagreed, saying that postpartum depression, which occurs in the first five weeks after delivery at a rate three times greater than in a control group of non-pregnant women, often can be predicted by history, poor social support, marital strife and poor bonding with the infant. She said a drug like Paxil can be prescribed prophylactically for high-risk women.
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Pregnancy and Miscarriage: Dr. John Larsen, a specialist in maternal-fetal (high-risk) pregnancy at George Washington University Medical Center, will be online at 1 p.m. ET to discuss pregnancy and miscarriage.
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Beyond Miscarriage (The Washington Post, Mar 1, 2005)
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Still, anticipatory prescribing before the end of pregnancy would lead some women to receive a drug they might not need -- an approach that might be difficult for an obstetrician to justify.
The same factors are not involved in the decision on whether to breast-feed an infant when the mother is taking antidepressants. The direct effects on the infant -- of both the mother's depression and the drug to treat it -- are less severe.
First, the amount of the drug expressed in breast milk is less than one one-hundredth of what the fetus receives in the womb. Second, the mother may decide to continue the drug but stop breast-feeding, whereas she doesn't have a similar option while she's pregnant.
The long-term health benefits of breast-feeding to the infant are well known. Holzman said that breast-feeding while on antidepressants is probably safe, and he doesn't recommend that mothers avoid it because of the medicine.
While the mother is still pregnant, the risk/benefit equations are more complex because two beings are involved. But by considering the mother first, and making sure she is in the best health possible, the baby tends to do better. This is why many obstetricians support the use of antidepressants during pregnancy. It is not a perfect situation, but for many women the risks of the disease far outweigh the risks of the drug.
"The number one person to treat is the mom," said Sreedhar Gaddipati, assistant professor of maternal fetal medicine and director of labor and delivery at New York-Presbyterian Hospital/Columbia University. "You have to ask yourself, 'Is this the same treatment you would give her if she weren't pregnant?' This is your starting point.
"Of course, once you've decided that she needs treatment, you have to choose the course of treatment that is the least toxic to the fetus."•
Resources
• Postpartum Support International offers information on postpartum depression and maternal care: www.postpartum.net/
• CERHR (Center for the Evaluation of Risks to Human Reproduction) has scientific reports on drugs' and other chemicals' effects on fetal development: cerhr.niehs.nih.gov/
• WebMD (enter "depression and pregnancy" in the search field of this consumer Web site for several good articles and reports): www.webmd.com
Marc Siegel, an associate professor of medicine at the New York University Medical School, last wrote for Health about heart bypass surgery.
