Neonatal Morbidity After Maternal Use of Antidepressant Drugs During Pregnancy

Abstract

To estimate the rate of admissions to NICUs, as well as infants' morbidity and neonatal interventions, after exposure to antidepressant drugs in utero.METHODS: Data on pregnancies, deliveries, prescription drug use, and health status of the newborn infants were obtained from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register. We included 741 040 singletons, born between July 1, 2006, and December 31, 2012. Of the infants, 17 736 (2.4%) had mothers who used selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Infants exposed to an SSRI were compared with nonexposed infants, and infants exposed during late pregnancy were compared with those exposed during early pregnancy only. The results were analyzed with logistic regression analysis. RESULTS:After maternal use of an SSRI, 13.7% of the infants were admitted to the NICU compared with 8.2% in the population (adjusted odds ratio: 1.5 [95% confidence interval: 1.4-1.5]). The admission rate to the NICU after treatment during late pregnancy was 16.5% compared with 10.8% after treatment during early pregnancy only (adjusted odds ratio: 1.6 [95% confidence interval: 1.5-1.8]). Respiratory and central nervous system disorders and hypoglycemia were more common after maternal use of an SSRI. Infants exposed to SSRIs in late pregnancy compared with early pregnancy had a higher risk of persistent pulmonary hypertension (number needed to harm: 285).CONCLUSIONS: Maternal use of antidepressants during pregnancy was associated with increased neonatal morbidity and a higher rate of admissions to the NICU. The absolute risk for severe disease was low, however.

Risk of adverse perinatal outcomes among women with pharmacologically treated and untreated depression during pregnancy: A retrospective cohort study

“…Our finding on the associations between antidepressants and adverse perinatal outcomes is consistent with previous results [14][15][16][17][18][20][21][22] ; however, most of the previous studies used no depression or no antidepressant use as a comparator, did not account for current depression and history of antidepressant use, and did not undertake plausible as these definitions have similar sensitivity, specificity, and predictive values in identifying depression cases from administrative data. 24 Overall, study findings suggest that studies that consider the influence of depression during pregnancy and maternal history of antidepressant and account for measured/unmeasured confounding are essential if we expect to develop clinical guidelines for antidepressant use in pregnancy.…”

“…[10][11][12][13] Furthermore, studies have also shown that pregnant women who use antidepressants to treat depression are at increased risk of adverse neonatal and childhood outcomes. 7,[10][11][12][14][15][16][17][18][19] Although progress in the utilisation of appropriate study designs and analytical approaches is being made to examine the association between antidepressant use during pregnancy and adverse perinatal outcomes, more research is needed to enhance our understanding about the association. To illustrate, previous studies that examined the risk of adverse perinatal outcomes associated with antidepressant use have not always taken into consideration the effect of the underlying condition itself, that is, depression.…”

“…Most of the previous studies examined perinatal outcomes in a group of women exposed to antidepressants compared to a group of women with no depression or a group of women who were not exposed to antidepressants. [14][15][16][17][18][20][21][22] This type of analysis is problematic, as the underlying condition itself (depression) independently increases the risk of adverse pregnancy outcomes. Furthermore, history of depression, pre-conception antidepressant use, and adherence to antidepressants during pregnancy, which are linked to perinatal outcomes, may also influence the risk of adverse outcomes associated with antidepressant use during pregnancy.…”

Selective Serotonin Reuptake Inhibitors during Pregnancy: Do We Have Now More Definite Answers Related to Prenatal Exposure?

“…In a large population based study using the Swedish Medical Birth Registry, the authors examined the perinatal outcome of 741,040 singleton births from 2006 to 2012. SSRIs were used by 17,736 mothers (2.4%) (Nörby et al, ). Of these newborns, 13.7% were admitted after birth to the neonatal intensive care unit for various reasons compared with 8.2% in the nonexposed newborns (aOR, 1.5; 95% CI, 1.4–1.5).…”

The safety of antidepressants in pregnancy

“…6 7 Neonatal "adaptation" problems, however, seem to be caused by treatment. 10 Other associations are still disputed, such as a link with septal heart defects. 9 This link is so consistent across populations, that it should be discussed with patients regardless of the true causality of the relation.…”