Data Reassures of the Probable Safety of SSRIs in Pregnancy

There is no association between in utero exposure to selective serotonin reuptake inhibitors (SSRIs) and stillbirth, neonatal mortality, and infant growth rate during the first year of life, according to the results of 2 unrelated studies.^1,2
   
In the first study, researchers investigated whether use of SSRIs during pregnancy increased the risk of stillbirth or neonatal mortality by analyzing data from a large national database in Denmark.¹ In utero exposure to SSRIs was divided into trimester-first, second, or third. During the study period (1995-2008), there were 920,620 identified births. Of these, the stillbirth rate was 0.45% and the neonatal mortality rate was 0.34%. A total of 12,425 neonates had in utero exposure to SSRIs, including fluoxetine, citalopram, escitalopram, paroxetine, and sertraline. Multivariate logistic regression models were used to determine whether SSRI exposure increased the risk of stillbirth or neonatal death.
   
The results showed that neither stillbirth nor neonatal mortality was associated with SSRI use during pregnancy. The adjusted odds ratios for stillbirth and SSRI use in the first trimester; first and second trimesters; and first, second, and third trimesters were 0.77, 0.84, and 1.06, respectively. In addition, the odds ratios for neonatal mortality and SSRI use in the corresponding trimesters were 0.56, 0.90, and 1.27, respectively. These findings further reassure that SSRI use during pregnancy is probably safe.
   
The second study, conducted at Northwestern Medicine and unrelated to the previous study, examined whether SSRI during pregnancy impact’s infant growth over the first year of life.² Maternal depression has been suggested to diminish infant growth, and there have been concerns about reduced growth in the first year of life among infants whose mothers used antidepressants during pregnancy.
   
Overall, infants with in utero exposure to SSRIs had measurements of weight, length, and head circumference during their first 12 months that were similar to those for infants whose mothers did not have depression and did not use SSRIs during pregnancy.² SSRI use during pregnancy was associated with shorter birth length, but this difference disappeared by 2 weeks of age. The growth measurements of infants born to women with depression who did not take SSRIs were similar to those of the general population.
   
Together, these findings offer additional reassurance that SSRI use during pregnancy is relatively safe. Although the use of SSRIs during pregnancy cannot be considered unequivocally safe, these findings offer additional reassurance that the benefits of SSRI use probably outweigh any harm.

Pertinent Points:
- The study findings show no association between in utero exposure to SSRIs and stillbirth or neonatal mortality.
- The use of SSRIs during pregnancy has no effect on infant growth during the first year of life.
 

References:

1. Jimenez-Solem E, Andersen JT, Petersen M, et al. SSRI use during pregnancy and risk of stillbirth and neonatal mortality. Am J Psychiatry. 2013;170:299-304.
2. Wisner KL, Bogen DL, Sit D, et al. Does fetal exposure to SSRIs or maternal depression impact infant growth? Am J Psychiatry. March 20, 2013. [Epub ahead of print]