The authors used national registry data to examine the relationship between pre-birth SSRI treatment and pregnancy complications while controlling for the effects of the psychiatric diagnoses related to SSRI use. Some previous studies had just compared people who took SSRIs to people who did not and ignored the fact that conditions like depression are also associated with worse pregnancy outcomes.
This most recent study was published online in advance of print publication in the American Journal of Psychiatry.
The authors looked at pregnancies in a large Finnish registry and compared women who took SSRIs, with women with psychiatric diagnoses who did not take SSRIs, and with women without psychiatric diagnoses who also did not take SSRIs.
The authors looked at conditions that have in the past been associated with SSRIs and pregnancy including hypertension of pregnancy/preeclampsia, vaginal delivery or cesarean section, and bleeding during or after delivery. They also looked at how the infant did, including whether they had late preterm (32 to 36 gestational weeks) and very preterm birth (less than 32 weeks), whether they were small for gestational age, and whether there were any neonatal problems.
They found some evidence for protective effect of SSRIs on certain adverse events.
Results from the study were summarized this way in Psychiatry News –
Women in the SSRI group had a lower risk of cesarean section, emergency or urgent cesarean section, and bleeding compared with those women who had a psychiatric diagnosis but did not take an SSRI. 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 certain neonatal complications in the baby, 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.
Pregnancy Complications Following Prenatal Exposure to SSRIs or Maternal Psychiatric Disorders: Results From Population-Based National Register Data. Heli Malm, M.D., Ph.D., Andre Sourander, M.D., Ph.D., Mika Gissler, Ph.D., David Gyllenberg, M.D., Ph.D.,Susanna Hinkka-Yli-Salomäki, Ph.Lic., Ian W. McKeague, Ph.D., Miia Artama, Ph.D., Alan S. Brown, M.D., M.P.H.. View Author and Article Information. Received: December 21, 2014. Accepted: May 11, 2015.