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SSRI use not linked to adverse pregnancy outcomes

Friday January 4, 2013
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In a study that included nearly 30,000 women from Nordic countries who had filled a selective serotonin reuptake inhibitor prescription during pregnancy, researchers found no significant association between use of these medications and risk of stillbirth, neonatal death or postneonatal death, after accounting for factors including maternal psychiatric disease.

"Depression during pregnancy is common, with prevalences ranging between 7% and 19% in economically developed countries," researchers wrote in background information for the study, which appears in the Jan. 2 issue of the Journal of the American Medical Association. "Maternal depression is associated with poorer pregnancy outcomes, including increased risk of preterm delivery, which in turn may cause neonatal morbidity and mortality.

"Use of selective serotonin reuptake inhibitors during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown."

Olof Stephansson, MD, PhD, of the Karolinska Institutet in Stockholm, and colleagues conducted a study to examine whether SSRI exposure during pregnancy was associated with increased risks of stillbirth, neonatal death and postneonatal death. The study included women with single births from all Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) at different periods from 1996 through 2007.

The researchers obtained information on maternal use of SSRIs from prescription registries, while maternal characteristics, pregnancy and neonatal outcomes were obtained from patient and medical birth registries. The authors estimated relative risks of stillbirth, neonatal death and postneonatal death associated with SSRI use during pregnancy after accounting for maternal characteristics and previous psychiatric hospitalization.

Among 1,633,877 singleton births in the study, there were 6,054 stillbirths, 3,609 neonatal deaths and 1,578 postneonatal deaths. A total of 29,228 (1.79%) of mothers had filled a prescription for an SSRI during pregnancy.

The researchers found that women exposed to an SSRI had higher rates of stillbirth (4.62 vs. 3.69 per 1,000) and postneonatal death (1.38 vs. 0.96 per 1,000) than those who did not. The rate of neonatal death was similar between groups (2.54 vs. 2.21 per 1,000). "Yet in multivariate models, SSRI was not associated with stillbirth, neonatal death or postneonatal death," the authors wrote, noting the increased rates "were explained by the severity of the underlying maternal psychiatric disease and unfavorable distribution of maternal characteristics such as cigarette smoking and advanced maternal age."

"However, decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness," the researchers concluded.

The study abstract is available at http://jama.jamanetwork.com/article.aspx?articleid=1555130.


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