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It has been demonstrated that serotonin increases chorionic vein and umbilical artery vasoconstriction, leading to reduced placental blood circulation, a major underlying factor in the development of preeclampsia (Palmsten et al., 2012). In assessing the effects of SSRIs on the prevalence of preeclampsia, it is particularly important to control for maternal depression, as there is a well-documented connection between the two (Reis and Källén, 2010; Toh et al., 2009). De Vera et al. (2012) found a 53% increased risk of pregnancy-induced hypertension associated with intrauterine antidepressant use, independent of maternal age or depression symptoms. Other studies have found important connections between the timing of SSRI exposure and preeclampsia (De Vera et al., 2012). Palmsten et al. (2011) found that women with depression diagnoses and antidepressant dispensings between gestational weeks 10 and 20 were at particular risk for preeclampsia. Toh et al. (2009) reported that the risk for preeclampsia among women who continued SSRI treatment after the first trimester was 15.2% while the risk for women who discontinued treatment before the end of the first trimester was only 3.7%. The same researchers also found that the risk of preeclampsia in women who were not treated with SSRIs (2.4%) was comparable to the risks in women who discontinued their treatment.

Postpartum hemorrhage is another important risk for mothers, but the increased risk with SSRIs is more poorly characterized than that of preeclampsia (Palmsten et al., 2013). Postpartum hemorrhage is the leading cause of maternal morbidity worldwide, and incidence in the US has increased since the 1990’s (Palmsten et al., 2013). It has been proposed that because serotonin contribu...

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...pression, many women are opting for alternative/complementary therapies. Of these methods, only BLT has sufficient supporting literature to be used as a reliable treatment in place of traditional pharmacologic therapies (Freeman, 2009). Although the literature is sparse, treatment options such as supplementing with omega-3 fatty acids, folate, and vitamin D may be beneficial. In addition, exercise, acupuncture, CES, and SAMe could prove to be helpful in certain patients when combined with traditional therapy; however, further research needs to be done on these alternative methods in order to validate them as legitimate treatment options. When working with these patients, it is important for the healthcare provider to bear in mind the severity of the patient’s symptoms, prior psychiatric history, and the benefit to risk ratio when deciding upon a final treatment plan.