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Research finds lower risk for preterm birth among pregnant women taking SSRIs

Women with psychiatric disorders who used selective serotonin reuptake inhibitors during pregnancy had a lower risk for late preterm and very preterm birth compared with women with psychiatric disorders not taking selective serotonin reuptake inhibitors during pregnancy.

“Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used antidepressants during pregnancy, with 4% to 10% of pregnant women in Finland and in the United States receiving prescriptions for SSRIs,” Heli Malm, MD, PhD, of University of Helsinki and Helsinki University Hospital, Helsinki, Finland, and colleagues wrote. “While considered relatively safe, SSRI use during pregnancy has been associated with an increased risk for several pregnancy complications, including preterm birth, small-for-gestational-age offspring, and postpartum hemorrhage. Other reported adverse outcomes include poor neonatal adaptation and persistent pulmonary hypertension of the newborn.”

Researchers assessed national register data for 845,345 children representing all singleton live births in Finland from 1996 through 2010. These data were cross-referenced with the Drug Reimbursement Register to identify those who purchased SSRIs and with Hospital Discharge Register data to identify mothers’ psychiatric history.

Pregnancies were categorized as exposed to SSRIs (n = 15,729), unexposed to SSRIs with psychiatric diagnosis (n = 9,652) and unexposed to medications and psychiatric diagnoses (n = 31,394).

Children of mothers who received SSRIs during pregnancy had a lower risk for late preterm birth (OR = 0.84; 95% CI, 0.74-0.96), very preterm birth (OR = 0.52; 95% CI, 0.37-0.74) and cesarean section (OR = 0.7; 95% CI, 0.66-0.75), compared with children of mothers with psychiatric disorders, but unexposed to medications.

However, mothers taking SSRIs had a higher risk for neonatal complications, including low Apgar score (OR = 1.68; 95% CI, 1.34-2.12) and monitoring in a neonatal care unit (OR = 1.24; 95% CI, 1.14-1.35).

When compared with children of mothers unexposed to medication and with no psychiatric disorders, children of mothers taking SSRIs and mothers with psychiatric disorders not taking SSRIs had higher risk for many adverse pregnancy outcomes, including cesarean section and need for monitoring in a neonatal care unit.

“We found that SSRI use during pregnancy is associated with a lower risk of late preterm and very preterm birth compared with women who had a psychiatric diagnosis but were not treated with antidepressants during pregnancy,” Malm and colleagues wrote. “These divergent findings reinforce the view that the decision on whether to prescribe an SSRI during pregnancy should be individualized to the mother’s medical and psychiatric history.” – by Amanda Oldt

Disclosure: Malm reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.