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How Risky Are SSRIs During Pregnancy?

In this population-based study, risks increased for infant respiratory distress and low birth weight.

Debate continues as to whether infants of women taking antidepressants have worse birth outcomes and, if so, whether the risks are due to the medication or to the psychiatric condition. To learn more, researchers compared birth outcomes in infants whose mothers had an ICD-9 depressive diagnosis and filled a prescription for an SSRI (most commonly, paroxetine, fluoxetine, and sertraline) but not for any other psychotropic medication; infants whose depressed mothers did not receive antidepressants; and infants whose mothers had no depression diagnoses and took no psychotropic medications.

The data came from registries of births and prescriptions and hospital and outpatient records concerning 119,547 live births that took place from 1998 to 2001 in British Columbia, Canada. To attempt to control for illness severity, the investigators used "propensity score matching," which matched mothers according to their total scores on indirect measures of depression severity (e.g., number of visits to physicians and to psychiatrists, times diagnosed with depression, and history of prescriptions for antipsychotic drugs or tricyclic antidepressants).

In analyses with propensity score matching, SSRI-exposed infants had a greater incidence of respiratory distress and birth weight below the 10th percentile than did unexposed infants of depressed mothers. Several other outcomes (e.g., shorter pregnancy and longer hospital stay) were not more common in SSRI-exposed neonates than in neonates born to depressed mothers who did not take antidepressants.

Comment: The authors could not control for comorbid psychiatric disorders or for use of tobacco, alcohol, and drugs, and could use only very indirect measures of depression severity. Thus, the authors might easily have overlooked differences in severity between the two depression groups. Still, respiratory distress in the SSRI-exposed infants might be related to SSRI use. Although the clinical implication of this finding is unclear, serotonin does affect pulmonary vascular tone and other aspects of prenatal development, and elevated levels associated with serotonin reuptake inhibition could be problematic for developing lungs.

— Steven Dubovsky, MD

Published in Journal Watch Psychiatry September 18, 2006

Citation(s):

Oberlander TF et al. Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry 2006 Aug; 63:898-906.

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