Alice Domar, PhD, (left), executive director of Harvard's Domar Center for Mind/Body Health, and Hope Ricciotti, MD, (right), associate professor of obstetrics and gynecology at Harvard Medical School, at

By Alice Domar and Hope Ricciotti Courtesy of

About 10% to 20% of women experience depression during pregnancy, but only 2.3% take antidepressant medication to treat it. It is natural for moms-to-be to hesitate to take any kind of medication for fear that it might harm their unborn baby, especially since some studies have shown there may be some basis for this worry.

However, depressed women who aren't treated during pregnancy can suffer greatly: they are not as able to care for themselves during their pregnancy, and can't handle the challenges of caring for a newborn.

Now studies have suggested that certain antidepressants taken during pregnancy—or possibly the depression itself—may be linked to a higher risk of preterm birth and neonatal complications. So what's a woman to do?

Normally, it is relatively easy to answer such a question. Simply do a randomized study; for example, take 1000 people with a certain condition, and then split them in half—500 take the medication, and 500 take a sugar pill. If the people on the medication have more complications than those on the sugar pill, then you know the medication is causing the problem. But with depression and pregnancy it is tricky. It doesn't feel right to take 1000 depressed pregnant women and only treat half of them with an antidepressant. Letting the other half be sad and miserable during their pregnancy, for the sake of science, feels pretty uncomfortable.  And if we're not sure the medication is safe in pregnancy, we can't ethically try it out on pregnant women.

To try to answer the question, a research team conducted a new study, which was published in March, 2009, in the American Journal of Psychiatry. The researchers simply observed a group of almost 300 pregnant women. Most of these women were mentally healthy, but some had a history of depression or became depressed during the pregnancy. Some women took antidepressants for their whole pregnancy or part of their pregnancy. Other women did not take medication at all and remained depressed the entire time, and some took no medication but were only depressed for part of their pregnancy.

The researchers found that women who took antidepressants the whole pregnancy and women who did not take any medication, but were depressed the entire pregnancy had a far higher rate of premature delivery than other women.

Women who were depressed only part of the time and the women who took medication for only part of the pregnancy had a premature delivery rate of 4% to 9%, compared with 20% in those who took antidepressants or were depressed for their entire pregnancy.

The results may seem confusing—it feels counterintuitive that untreated depression carries the same risk as medication during pregnancy. However, the take home message is that there is a real link between depression, whether or not it is treated, and the risk of preterm birth.

And preterm birth can have a long-term impact on a child. A study in the April issue of the journal Pediatrics looked at babies born just a little bit premature—34-36 weeks of gestation compared to 37-40 weeks for a full term pregnancy. These "late pre-term babies" were 36% more likely than full-term infants to have developmental delays, be held back in kindergarten, or to require special education assistance.

So the recent link between depression and preterm birth needs to be taken seriously.

Women with a history of depression should carefully evaluate their medication and treatment choices for maximizing mental health prior to attempting pregnancy. Once pregnant, be honest with your obstetrician about your mental health history, and depressive symptoms throughout your pregnancy.

And use all your tools to prevent and treat depression, including therapy, medications, support from family and friends, relaxation techniques, good sleep habits, and plenty of exercise.  Most importantly, don't let the stigma prevent you from getting the help you need.

Depression is a common problem for both men and women. All of us feel down from time to time, but depression is mental pain that is constant and severe, affecting your ability to concentrate, sleep, and even your health. It is more common in women, and the chance of depression is highest in a woman's life during or just after pregnancy. It is thought that the hormones of pregnancy, along with some of the extra stressors that go with pregnancy and parenting, together account for this increase.

Depression often goes undiagnosed and untreated.  Embarrassment, hopelessness, and apathy often keep women from bringing depression to the attention of their health care providers. Don't let this happen to you. Treatment for depression, either with medications, therapy, or both, can shorten the duration and intensity of depression.

Read more from Dr. Alice Domar, executive director of Harvard's Domar Center for Mind/Body Health, and Dr. Hope Ricciotti, associate professor of obstetrics and gynecology at Harvard Medical School, at