Maternal antidepressant use poses risk for newborn respiratory distress, preterm birth
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Maternal antidepressant use increases the risk for newborn respiratory distress and preterm birth, according to a study published in Pediatrics.
Gretchen Bandoli, PhD, an assistant professor of pediatrics at the University of California, San Diego, and colleagues found that there was an increased risk for newborn respiratory distress among babies born to mothers with low, moderate or high use of antidepressants, and an increased risk for preterm birth associated with moderate to high sustained doses compared with low use.
They could not rule out that the findings could be explained y the severity of depression or anxiety.
“We stress our conclusion that our findings support continuation of the lowest effective dose to treat depression and anxiety, which benefits the mother and her offspring,” Bandoli told Healio. “Both preterm birth and respiratory distress remain fairly uncommon in pregnancy. However, our findings support additional awareness and potentially monitoring for these outcomes and provide more specific exposure definitions for clinicians to consider when providing for expectant mothers.”
The study included 15,041 pregnancies in which there was antidepressant use and a delivery from 2012 through 2016. Bandoli and colleagues observed patterns of antidepressant use and categorized them into five different types: low use (~10 mg/daily) with first trimester reduction; low sustained use (~20 mg/daily); moderate use (~40 mg/daily) with first trimester reduction; moderate sustained use (~40 mg/daily); and high sustained use (~75 mg/daily).
The researchers found an increased risk for preterm birth in moderate (prevalence = 15%) to high (prevalence = 24%) sustained antidepressant use compared with the lowest dose with early discontinuation (prevalence = 10%), Bandoli explained. They also found that all patterns of use increased the risk for neonatal respiratory distress in a dose-response fashion, with adjusted RRs of 1.36 (95% Ci, 1.2-1.5) to 2.23 (95% CI, 1.83-2.77).
“We cannot rule out unmeasured confounding to partially explain these findings,” Bandoli said.
“Our findings of increased risk estimates for preterm birth in the sustained exposure groups were not unexpected and may explain some of the null findings in other studies, when estimates across patterns such as these are collapsed down to any use,” she said. “Findings for [increased risk for cardiac] malformations, which attenuated when compared to depression not treated with antidepressants, were consistent with previous studies. The findings for respiratory distress, which were elevated for all patterns of use compared to the lowest use group, were of interest.”
Bandoli encouraged other researchers “to conduct similar analyses, particularly focusing on early pregnancy, and including pregnancies where antidepressant treatment was discontinued before mid-gestation.”
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