SSRI's During Pregnancy: Do They Really Hurt the Babies?

Background: There have been reports that maternal use of selective serotonin reuptake inhibitors (SSRIs) in late pregnancy is associated with neonatal complications, in particular respiratory distress. Given the sparse data available, and the lack of clinical trials assessing efficacy and safety of the use of SSRIs in pregnant women, we conducted a review of the birth records of children born to mothers who were patients at a tertiary care reproductive mental health clinic.

Methods: Data were abstracted from both maternal and infant hospital charts. Outcomes of neonates whose mothers used SSRIs in late pregnancy [LP] (N=140), used SSRIs only in early pregnancy [EP] (N=45), or did not use SSRIs during pregnancy [NP] (N=215) were compared using nonparametric tests.

Results: No significant differences between groups were found in frequency of respiratory distress, tachycardia, irritability, admission to neonatal intensive care unit, major or minor malformations. Similar results were observed when only mothers with significant symptoms of depression (Edinburgh Postnatal Depression Scale scores ≥ 11) were considered.

Conclusions: In this sample, maternal use of SSRI antidepressants in late pregnancy was not associated with neonatal events of clinical significance. Notwithstanding, the findings are limited by a modest sample size and retrospective design. Additional research, including careful documentation of SSRI exposure and standardized assessment of neonates, is urgently required to aid risk-benefit decision making in treating pregnant women with depression.

References:

(1) Moses-Kolko EL, Bogen D, Perel J, Bregar A, Uhi K. Levin B, Wisner KL. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors: literature review and implications for clinical applications. JAMA. 2005; 293:2372–83.

(2) Koren G, Matsui D, Einarson A, Knoppert D, Steiner M. Is maternal use of selective serotonin reuptake inhibitors in the third trimester of pregnancy harmful to neonates? Canadian Medical Association Journal, 2005; 172:1457–9.