By: 3 April 2013

In a recent study of nearly 30,000 women from Nordic countries, researchers found no significant association between use of selective serotonin reuptake inhibitor (SSRI) drugs during pregnancy and risk of stillbirth, neonatal death, or post-neonatal death.

The study, published in the journal JAMA, accounted for factors including maternal psychiatric disease.

“Depression during pregnancy is common with prevalences ranging between seven percent and 19 percent in economically developed countries. Maternal depression is associated with poorer pregnancy outcomes, including increased risk of preterm delivery, which in turn may cause neonatal morbidity and mortality,” the authors wrote. “Use of selective serotonin reuptake inhibitors during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown.”

The study, carried out by Olof Stephansson, MD, PhD, of the Karolinska Institutet, Stockholm, Sweden and colleagues included women with single births from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) at different periods from 1996 through 2007. The researchers obtained information on maternal use of SSRIs from prescription registries; maternal characteristics, pregnancy, and neonatal outcomes were obtained from patient and medical birth registries. The authors estimated relative risks of stillbirth, neonatal death, and post-neonatal death associated with SSRI use during pregnancy taking into account maternal characteristics and previous psychiatric hospitalisation.

From the 1,633,877 singleton births in the study, 6,054 were stillbirths; 3,609 were neonatal deaths; and 1,578 were post-neonatal deaths. A total of 29,228 (1.79 percent) of mothers had filled a prescription for an SSRI during pregnancy. The researchers found that women exposed to an SSRI had higher rates of stillbirth (4.62 vs. 3.69 per 1000) and post-neonatal death (1.38 vs. 0.96 per 1000) than those who did not. The rate of neonatal death was similar between groups (2.54 vs. 2.21 per 1000).

“In multivariate models, SSRI use was not associated with stillbirth, neonatal death, or post-neonatal death. Estimates were further attenuated when stratified by previous hospitalisation for psychiatric disease,” the authors wrote.

“The present study of more than 1.6 million births suggests that SSRI use during pregnancy was not associated with increased risks. … The increased rates of stillbirth and post-neonatal mortality among infants exposed to an SSRI during pregnancy were explained by the severity of the underlying maternal psychiatric disease and unfavourable distribution of maternal characteristics such as cigarette smoking and advanced maternal age.

“However, decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness,” the researchers concluded.