Finnish, American, and Swedish researchers analyzed data from Finnish national registries to compare outcomes for pregnant women exposed to SSRIs (N=15,729) with those who had a psychiatric diagnosis but did not use any SSRIs (N=9,652) and those who had no psychiatric diagnosis and no exposure to SSRIs (N=31,394).
The outcomes of interest were diagnoses related to pregnancy and delivery, including hypertension of pregnancy/preeclampsia, vaginal delivery or cesarean section, and bleeding during or after delivery. The researchers also looked at neonatal outcomes, including late preterm (32 to 36 gestational weeks) and very preterm birth (less than 32 weeks), small for gestational age, and neonatal problems, including a five-minute Apgar score less than 7, neonatal breathing problems, monitoring in a neonatal intensive care unit, and hospital stay at 7 days of age.
Women in the SSRI group had a lower risk of cesarean section, emergency or urgent cesarean section, and bleeding compared with women who had a psychiatric diagnosis but no medication (but a higher risk of cesarean section than women with no exposure and no diagnosis). Moreover, compared with the psychiatric diagnosis/no medication group, the SSRI group had a 16% lower risk of late preterm birth and a 48% lower risk of very preterm birth.
However, in SSRI-treated mothers, the risk was higher for offspring neonatal complications, including low Apgar score and monitoring in a neonatal intensive care unit.
AJP Editor Robert Freedman, M.D., told Psychiatric News that because both groups of women with psychiatric diagnoses in the study experienced problems, it suggests the illnesses themselves may be a major contributor to the risks previously ascribed to SSRIs. “However, the post-birth reaction of the baby to withdrawal from the maternal SSRI lowers Apgar scores and requires neonatal monitoring, sometimes for as long as a week. These babies are then discharged home with no known further consequences,” he added.
Freedman noted that the CDC and similar agencies in other countries monitor drug side effects and report them, even if they are rare, to alert clinicians and their patients of the existence of such side effects and their approximate frequency, but the CDC and other agencies do not generally conduct a risk-benefit analysis to directly guide clinical decisions.
“Prenatal depression is associated with a number of ill effects, not only on the health of the mother, but also on the fetus. These include shorter gestation with its attendant decrease in fetal development, poorer maternal-infant bonding, and slight but significant increase in the long-term risk for psychiatric illnesses ranging for autism spectrum disorder to schizophrenia,” he said. “If a mother has major depressive disorder or a similar serious anxiety disorder during pregnancy, generally treatment with appropriate medication and psychotherapy should be part of her regimen, but she and the father need to be fully aware of the calculus of risks and benefits of treatment versus no treatment that inform this decision.”
For related information, see the Psychiatric News article “SSRI Use in Late Pregnancy May Slightly Increase Risk of Newborn Respiratory Disease.