Another Puzzle Piece for Expectant Moms

SSRI antidepressants during pregnancy may not increase risk of newborn death

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Untreated mental disorders are linked to newborn complications in pregnant women. But taking psychiatric medication has risks too. Again, the old question: What, then, to do?

Doctors are constantly reassessing how to treat pregnant women with a history of mental illness. A recent study offers more information for piecing together this puzzle.

The study found that taking the most common class of antidepressants does not appear to increase the risk of stillbirth, newborn death or infant death.

Women who took antidepressants called selective serotonin reuptake inhibitors (SSRI) did not have a higher rate of deaths among their babies than women who did not take them.

"Attend all prenatal appointments."

The study, led by Olof Stephansson, MD, PhD, of the Centre for Pharmacoepidemiology and Clinical Epidemiology Unit at the Karolinska Institutet in Stockholm, Sweden, was based on a large population of pregnant women throughout Denmark, Finland, Iceland, Norway and Sweden.

All the 1.6 million women included in the study gave birth to single children (not twins or triplets).

Out of this population, 6,054 of the women had a stillbirth, where the baby dies any time after the 20th week of pregnancy while in the uterus. Another 3,609 women's children were classified as neonatal deaths, which means their babies died within the first 28 days of being born.

A total of 1,578 postneonatal deaths occurred in this population, which means the babies died between 29 days old and 1 year old.

Among the mothers, 1.79 percent (29,228 total) had filled a prescription for an SSRI during their pregnancy.

SSRIs are one of the most common classes of antidepressants. Some of the most common SSRIs are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft).

Looking only at the raw data without making adjustments for differences among the women, there was a very slightly higher rate of stillbirth and postneonatal death among the women who took SSRIs.

The women who took SSRIs had stillbirths at a rate of 4.62 births per 1,000 births, compared to 3.69 births per 1,000 among women who did not take SSRIs. The postneonatal death rate among women taking SSRIs was 1.38 per 1,000, compared to 0.96 per 1,000 among those not taking them.

However, these tiny differences vanished when the researchers made adjustments to take into account differences between the women's demographics and health histories, including previous psychiatric hospitalizations.

The researchers therefore concluded that the risk of a pregnant woman's baby dying — whether in the womb before birth, within the first month after birth or within the first year — was not increased if she took SSRI antidepressants.

However, other studies have found small increased risks with other conditions in women taking SSRIs, so "decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness," they wrote.

These other risks have included birth defects, neonatal withdrawal syndrome and high blood pressure in the newborn.

So far, there is not definitive research that shows that SSRIs will cause these problems or that untreated mental illness will cause these or other problems in the children.

Each women should discuss her particular health, mental health and life circumstances with her mental healthcare provider and her obstetrician or midwife to determine the best course for her during pregnancy.

The study was published January 2 in JAMA. The research was funded by the Swedish Pharmacy Company and the institutions of each author, including a postdoctorate scholarship from the Swedish Society of Medicine for one author.

The individual authors declared no conflicts of interest, and the Swedish Pharmacy Company had no role in the design or conduct of the study, including data collection, analysis and interpretation.

Reviewed by: 
Review Date: 
January 2, 2013
Last Updated:
January 5, 2013