Both untreated depression, SSRIs affect fetal outcomes

Untreated depression and treatment with selective serotonin reuptake inhibitors (SSRIs) during pregnancy appear to have a similar effect on fetal head growth. 

Clinicians should weigh the risks and benefits to the fetus of treating or not treating depression in pregnant patients.

Deciding whether to treat pregnant patients who are depressed with selective serotonin reuptake inhibitors (SSRIs) has become more complicated. A Dutch study of more than 7,600 pregnant women found that fetal head growth was slower in those with depression than in controls, whether or not the depression was treated with SSRIs.

Fetal head circumference has been shown to accurately predict brain weight, and multiple studies have linked small head size with behavioral problems and poorer cognitive performance later in life. 

In the prospective population-based study, ultrasound was used to track fetal development throughout pregnancy.  Fetuses of 570 women with untreated depressive symptoms showed reduced body growth (β= –4.4 g/week; 95% Confidence Interval [CI], –6.3 to –2.4; P<.001) and head growth (β= –0.08 mm/week; 95% CI, –0.14 to –0.03; P=.003).  They also gained less weight per week than fetuses of non-depressed controls, and gestation duration was slightly longer than that of controls, but was within the normal range of childbirth.

The 99 women who used SSRIs during pregnancy reported fewer depressive symptoms than those with untreated depression. Prenatal SSRI use was associated with reduced fetal head circumference but not reduced body growth (β= –0.18 mm/week; 95% CI: –0.32 to –0.07; P=.003). Further, SSRI-exposed offspring were twice as likely to be born preterm as those of non-depressed controls or women with untreated symptoms (odds ratio [OR], 2.14; 95% CI, 1.08 to 4.25; P=.03). The relationship held even after adjusting for maternal age, smoking status, body mass index, parity, education, ethnicity, and benzodiazepine use.

The authors suggest that clinicians carefully weigh treatment options and consequences for pregnant patients who have symptoms of depression, and that preconception programs be developed to identify and address symptoms of depression before conception.

The study was published online March 5 in the Archives of General Psychiatry.

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