According to the Los Angeles County Department of Public Health, 11% of females in the county suffer from depression; thus, a significant number of LA women become pregnant while taking antidepressants. Some studies have linked a common type of antidepressant, a
selective serotonin reuptake inhibitor (SSRI), to an increased risk of birth defects and newborn respiratory problems. However, whether SSRIs can increase the risk of a stillbirth is unclear. Therefore, researchers affiliated with the Karolinska Institute in Stockholm, Sweden conducted a study to determine whether these drugs could increase the risk of a stillbirth. They published their findings on January 2 in the Journal of the American Medical Association (JAMA).
Examples of SSRIs are Paxil, Prozac, and Zoloft). The researchers noted that maternal psychiatric disease is associated with adverse pregnancy outcomes. Use of SSRIs 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 Therefore, they designed a study to determine the risk of stillbirth and infant mortality associated with use of SSRIs during pregnancy.
The study group comprised 1,633,877 singleton births (single pregnancy) from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) at different periods from 1996 through 2007. The investigators 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 researchers used a technique known as logistic regression to estimate relative risks of stillbirth, neonatal death, and post-neonatal death associated with SSRI use during pregnancy; taken into account were maternal characteristics and previous psychiatric hospitalization.
The researchers found that among 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%) of mothers had filled a prescription for an SSRI during pregnancy. Women exposed to an SSRI presented with higher rates of stillbirth (4.62 vs. 3.69 per 1,000) and post-neonatal death (1.38 vs. 0.96 per 1,000 than those who did not. The rate of neonatal death was similar between groups (2.54 vs. 2.21 per 1,000). However, in multivariable models, SSRI use was not associated with stillbirth, neonatal death, or post-neonatal death. Estimates were further attenuated (decrease) when stratified by previous hospitalization for psychiatric disease. The adjusted odds ratio (OR) for stillbirth in women with a previous hospitalization for psychiatric disease was 0.92; it was 1.07 for those who had not been previously hospitalized. The corresponding ORs for neonatal death were 0.89 for women who were hospitalized and 1.14 for women who were not. For post-neonatal death, the ORs were 1.02 for women who were hospitalized and 1.10 for women who were not.
The authors concluded that among women with singleton births in Nordic countries, no significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or post-neonatal mortality. They cautioned, however, decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness.
Take home message:
All medication has associated risks; furthermore, medication taken during pregnancy has associated risks to the developing fetus. Thus, if antidepressant use can be avoided during pregnancy, that is the appropriate course of action. If you are taking antidepressants and are pregnant or contemplating pregnancy, you should consult a healthcare professional regarding the benefits versus the risks. Alternatives to antidepressants should be discussed.