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Untreated depression and its medication both linked to prenatal risks

Untreated maternal depression was associated with slower rates of fetal body and head growth, and while women who took selective serotonin reuptake inhibitors for maternal depression had fewer depressive symptoms, their fetuses were at increased risk for preterm birth and reduced head growth, data showed.

Hanan El Marroun, PhD, a postdoctoral fellow in the department of child and adolescent psychiatry at Sophia Children’s Hospital in Rotterdam, the Netherlands, and colleagues examined the effects of maternal selective serotonin reuptake inhibitor (SSRI) use in 7,696 pregnant women.

The researchers obtained participants’ self-reports and prescription records from pharmacies. Depressive symptoms were assessed using the Brief Symptom Inventory at an average of 20.6 weeks of gestation. Participants were classified into three groups: a control group of women not using SSRIs with low depressive symptoms (91.3%), women with clinically relevant depressive symptoms who were not using SSRIs (7.4%) and women using SSRIs during pregnancy (1.3%). To evaluate gestational age and fetal growth characteristics, the researchers performed fetal ultrasonography assessments in each trimester.

Fetuses from mothers with depressive symptoms showed reduced body growth (beta=–4.4 g per week; 95% CI, –6.3 to –2.4) and head growth (beta=–0.08 mm per week; 95% CI, –0.14 to –0.03). The severity of depressive symptoms in mothers who used SSRIs was significantly lower than mothers with depressive symptoms who did not use SSRIs. SSRI use was not associated with reduced fetal body growth, according to researchers, but the drug was associated with reduced fetal head growth (beta=–0.18 mm per week; 95% CI, –0.32 to –0.07). Children exposed to SSRI were at higher risk for preterm birth (OR=2.14; 95% CI, 1.08-4.2), as well.

Although the association between SSRI use and preterm birth has been demonstrated consistently in other studies based on hospital, health insurance or patient data, the association between SSRI use and fetal head growth has not, the researchers wrote.

Hanan and colleagues said there were several explanations for SSRI use affecting fetal head growth, including the possibility that past depression affects maternal physiology and could therefore also affect fetal development. Another explanation could be the manipulation of serotonin levels with SSRIs in utero that may directly affect fetal brain growth, or the presence of epiphenomena alongside SSRI use, such as smoking or drinking during pregnancy and low socioeconomic status — although the researchers had attempted to control for these risk factors in their analyses and were less likely to explain a specific effect on head size.

“Our findings further raise the question whether maternal SSRI treatment during pregnancy is better or worse for the fetus than untreated maternal depression,” the researchers wrote. “Clinicians must carefully weigh the known risks of untreated depression during pregnancy and the possible adverse effects of SSRIs.”

Disclosure: The researchers report no relevant financial disclosures.