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Increased attention should be paid to perinatal mental health and to the need of dedicated services
  1. Luisa Tomelleri1,
  2. Carmine M Pariante2
  1. 1 Department of Mental Health, Ulss 9 Scaligera, Verona, Veneto, Italy
  2. 2 Stress, Psychiatry and Immunology Laboratory, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Maurice Wohl Clinical Neuroscience Institute, London, UK
  1. Correspondence to Dr Luisa Tomelleri, Section of Psychiatry, Civile Maggiore Hospital, Verona 37126, Italy ; ltomelleri{at}

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BackgroundSetting the scene

Among pregnant women, up to 23% experience a depressive disorder, and up to 10% a generalised anxiety disorder.1 As reported by several studies, untreated depression (severe depression in particular) in pregnant women is associated with adverse birth outcomes, such as low birth weight, preterm delivery and developmental problems. Moreover, women with pre-existing psychiatric condition have high risk of relapse or worsening of symptoms during pregnancy.2 Similarly, anxiety disorders have been linked to the risk of preterm birth and delivery by caesarean section,3 but yet much remains to be understood about the effects of specific anxiety disorders, and the severity of their symptoms, on birth outcomes.

Antidepressants, such as selective serotonin reuptake inhibitors (SSRI), are prescribed to an increasing number of pregnant women (approximately 2%–8%) to treat depression and anxiety disorders.1 Although in the scientific literature SSRIs are generally reported to be quite safe during pregnancy,4 three recent studies raised concerns that these drugs may have a negative impact on fetal brain development with long-term consequences on offspring, especially autism. Focusing on exposure to SSRIs in utero and risk of autism, Brown and colleagues analysed data from nearly 36 000 births in Ontario, Canada, between 2002 and 2010.5 A second study investigated the association between in utero antidepressant exposure and overall psychiatric disorders in offspring, examining specific subcategories, including autism spectrum disorder.6 Finally, in a prospective study, Yonkers and colleagues analysed the correlations between the use of medications in panic disorder and generalised anxiety disorder with adverse maternal and neonatal pregnancy complications.7

In this commentary we will bring some consideration about perinatal psychiatric illness and its treatment, focusing on the three influential studies mentioned.5–7

What do these papers add?

In order to assess the association between serotonergic antidepressant exposure during pregnancy and child autism spectrum disorder, Brown et …

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  • Contributors LT drafted the commentary and CMP critically revised it.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.