SSRI antidepressants linked with lower risk of preterm birth

Pregnant women who take SSRIs to treat their depression have a lower risk of giving birth prematurely or having a caesarean section than pregnant women with depression who do not take medication, a study finds.

Pregnant women who take selective serotonin reuptake inhibitors (SSRIs) may be at lower risk of premature birth and caesarean section than women with depression who do not take SSRIs, suggests a study.

Pregnant women who take selective serotonin reuptake inhibitors (SSRIs) may be at lower risk of premature birth and caesarean section than women with depression who do not take SSRIs, a study[1]
suggests.

Researchers also found there was no increased risk of major malformations or persistent pulmonary hypertension in newborns exposed to SSRIs.

SSRIs are the most common antidepressants taken by pregnant women and previous research has linked them with various adverse outcomes. Up to 10% of pregnant women experience depression, which is linked with poorer pregnancy outcomes. 

Data from several national registries were used to compare three cohorts of women who had given birth in Finland between 1996 and 2010. Pregnant women with a psychiatric diagnosis — such as depression or anxiety — who collected one or more prescriptions for an SSRI during pregnancy (n=15,729) were compared with pregnant women who had a psychiatric diagnosis but did not take antidepressants (n=9,652) and pregnant women who had no psychiatric diagnosis and no antidepressant use (n=31,394).

Pregnant women who took an SSRI were at 16% lower risk of having a preterm birth and 48% lower risk of very preterm birth, compared with women who had a psychiatric diagnosis but did not take an SSRI (odds ratio [OR] 0.84 and 0.52, 95% confidence interval [CI] 0.74–0.96 and 0.37–0.74, respectively). 

Taking an SSRI also decreased the chance of the woman having a caesarean section and bleeding after giving birth. The risk of the baby being small for gestational age did not differ between the two groups. 

However, SSRI use was associated with several risks for newborns compared with babies born to mothers with psychiatric disorders who did not take medication, referred to as poor adaptation of the newborn by the authors. These included the chance of the baby having breathing problems (OR 1.40, 95% CI, 1.20–1.62), needing to go into a neonatal care unit (OR 1.24, 95% CI, 1.14–1.35), being in hospital at seven days of age (OR 0.89, 95% CI, 0.80–0.99) and having a worse Apgar score — a scale of overall newborn health (OR 1.68, 95% CI, 1.34–2.12). 

Commenting on the study, Adrienne Einarson, a nurse specialising in the risks of medication in pregnancy and a PhD candidate at the faculty of pharmacy, Utrecht, the Netherlands, says: “This will allow women who require treatment for depression in the perinatal period, to receive the medication they need without being made to feel guilty and unfit mothers.”

However, she notes that most studies have not been able to control for underlying depression in the mother, which is considered to be an important factor when examining adverse outcomes. The protective effect of SSRIs on preterm birth and caesarean section has not been seen before, she adds, but the effect is minimal on a population level.

Other risks associated with SSRIs were confirmed, such as poor neonatal adaptation characterised by weaker breathing, heart rate and muscle tone after birth.

Einarson says this is to be expected as some infants exposed to antidepressants during pregnancy experience withdrawal symptoms as a result of sudden discontinuation of the drug after birth, which has been reported previously. The authors of the study note that they couldn’t find any evidence that the condition was persistent.

References

[1] Malm H, Sourander A, Gissler M et al. Pregnancy complications following prenatal exposure to SSRIs or maternal psychiatric disorders: results from population-based national register data. The American Journal of Psychiatry 2015. http://dx.doi.org/10.1176/appi.ajp.2015.14121575.

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Citation
The Pharmaceutical Journal, PJ, 5 September 2015, Vol 295, No 7878;295(7878):DOI:10.1211/PJ.2015.20069174