Studies examine effects of prenatal antidepressant exposure on maternal, child outcomes

Three studies recently published in BJOG: An International Journal of Obstetrics and Gynaecology found little to no associations between prenatal exposure to antidepressants, delayed motor development at age 3 years and behavioral problems at age 7 years. However, antidepressant use during pregnancy was associated with significantly increased risk for postpartum hemorrhage.

To estimate the association between prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and motor development in children, Marte Handal, MD, PhD, of the Norwegian Institute of Public Health in Oslo, Norway, and colleagues examined population-based data from the Norwegian Mother and Child Cohort Study for 51,404 singleton pregnancies. Self-reports on SSRI use were collected 6 months before pregnancy and prospectively during pregnancy. Motor development was assessed by maternal reports when children were aged 3 years.

Overall, 381 women reported using SSRIs during pregnancy and of these, 159 reported prolonged use.

When adjusting for anxiety and depression symptoms before and during pregnancy, prolonged prenatal exposure to SSRIs was associated with a delay in fine motor development (OR = 1.42; 95% CI, 1.07-1.87) compared with no SSRI exposure.

Severity of maternal depression partially explained this association, according to Handal and colleagues.

In a separate study, Luke Grzeskowiak, PhD, of the University of Adelaide in South Australia, and colleagues investigated associations between prenatal exposure to antidepressants and behavioral problems among children. Using data from the Danish National Birth Cohort, Grzeskowiak and colleagues identified pregnant women with depression who took antidepressants during pregnancy (n = 210), women who were depressed and did not take antidepressants during pregnancy (n = 231), and pregnant women who were not depressed (n = 48,737). Childhood behavioral problems were assessed at age 7 years.

Researchers found no associations between prenatal antidepressant exposure and abnormal Strengths and Difficulties Questionnaire scores for overall problem behavior, hyperactivity/inattention or peer problems.

However, prenatal antidepressant exposure was associated with abnormal scores regarding emotional symptoms (adjusted RR = 1.68; 95% CI, 1.18-2.38) and conduct problems (aRR = 1.58; 95% CI, 1.03-2.42).

These associations were significantly attenuated for when adjusting for antenatal mood status, according to researchers.

Untreated prenatal depression was associated with an increased risk for all behavioral outcomes evaluated, including emotional, conduct, peer relationship, hyperactivity/inattention and pro-social skills. These associations were significantly attenuated for when adjusting for antenatal mood status.

Prenatal antidepressant use, maternal outcomes

Grzeskowiak also conducted a retrospective cohort study exploring antidepressant use in late gestation and postpartum hemorrhage.

Study participants included 558 women with late-gestation antidepressant exposure, 1,292 women with a psychiatric illness but no antidepressant use and 28,348 women with neither antenatal exposures.

Researchers defined postpartum hemorrhage as a recorded blood loss of 500 mL or more for vaginal delivieres and a loss of 1,000 mL or more for cesarean deliveries.

Women exposed to antidepressants had an increased risk for postpartum hemorrhage compared with women unexposed to antidepressants or psychiatric illnesses (adjusted RR = 1.53; 95% CI, 1.25-1.86).

Women with psychiatric illnesses who did not use antidepressants did not have an increased risk for postpartum hemorrhage compared with women unexposed to psychiatric illness and antidepressants.

In sensitivity analyses, late gestation antidepressant exposure was associated with an increased risk for severe postpartum hemorrhage (aRR = 1.84; 95% CI, 1.39-2.44) and postpartum anemia (aRR = 1.8; 95% CI, 1.46-2.22).

“The decision whether or not to use SSRIs during pregnancy must be considered on an individual basis as untreated maternal depression can itself be harmful. Pregnant women and mothers can be reassured from these studies which suggest there are no clinically important long term neurodevelopmental or behavioral problems associated with taking SSRIs,” Patrick O’Brien, of the Royal College of Obstetricians and Gynecologists, said in a press release. “While it is useful for women to be aware that SSRI use may increase the risk of postpartum hemorrhage, more research needs to be done to understand what is behind this increased risk. Women should not stop taking their medication without first discussing their options with their doctor and if necessary extra precautions can be taken to prevent postpartum hemorrhage at the time of birth.” – by Amanda Oldt

Disclosure: Please see the full studies for a list of all authors’ relevant financial disclosures.

Reference:

Grzeskowiak LE, et al. BJOG. 2015;doi:10.1111/1471-0528.13611.

Grzeskowiak LE, et al. BJOG. 2015;doi:10.1111/1471-0528.13612.

Handal M, et al. BJOG. 2015;doi:10.1111/1471-0528.13582.