Olof Stephansson, M.D., Ph.D., of the Karolinska Institutet, Stockholm, Sweden and colleagues reported the results of the largest study ever done to examine the correlation of the use of selective serotonin reuptake inhibitors (SSRI) by pregnant women and the instances of increased risks of stillbirth, neonatal death, and post neonatal death in the January 2, 2013, issue of the Journal of the American Medical Association.
Among 1,633,877 singleton births in the study, there were 6,054 stillbirths; 3,609 neonatal deaths; and 1,578 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).
"Depression during pregnancy is common with prevalence ranging between 7 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," according to the authors.
“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 researchers advise a case by case analysis to prevent stillbirth, neonatal death, and post neonatal death.
Ongoing litigation in Alabama asserts that the SSRIs Celexa (citalopram), Luvox (fluvoxamine), Lexapro (escitalopram), Paxil (paroxetine), Prozac (fluoxetine), Symbyax (olanzapine/fluoxetine) and Zoloft (sertraline) are associated with a number of birth defects.
The research was funded by the Swedish Pharmacy Company and reviewed at the Eureka Alert website the date of publication.