A study of nearly 30,000 women who filled a selective serotonin reuptake inhibitor (SSRI) prescription during pregnancy found no significant association between use of the antidepressants and risk of stillbirth, neonatal death, or postneonatal death — even after accounting for factors including maternal psychiatric disease.
A study conducted by Olof Stephansson, M.D., Ph.D., of the Karolinska Institutet, Stockholm, Sweden, and colleagues included women from Denmark, Finland, Iceland, Norway and Sweden at different periods from 1996 through 2007.
The researchers obtained information on maternal use of SSRIs from prescription registries. Maternal characteristics, pregnancy, and neonatal outcomes were obtained from patient and medical birth registries.
Among 1,633,877 single births, there were 6,054 stillbirths, 3,609 neonatal deaths and 1,578 postneonatal deaths. A total of 29,228 (1.79 percent) of mothers had filled a prescription for an SSRI during pregnancy, the researchers report in the study.
The study found that women exposed to an SSRI had higher rates of stillbirth (4.62 vs. 3.69 per 1,000) and postneonatal death (1.38 vs. 0.96 per 1,000) than those who did not.
However, the slightly elevated rates were attributed to the severity of the underlying psychiatric disease — most often depression — than with its treatment. The researchers also noted that women who were more likely to be in this elevated risk group also had higher rates of negative maternal characteristics, such as smoking or being older when giving birth.
The rate of neonatal death was similar between groups (2.54 vs. 2.21 per 1,000).
“The present study of more than 1.6 million births suggests that SSRI use during pregnancy was not associated with increased risks of stillbirth, neonatal death, or postneonatal death,” the researchers said in the study.
“The increased rates of stillbirth and postneonatal mortality among infants exposed to an SSRI during pregnancy were explained by the severity of the underlying maternal psychiatric disease and unfavorable distribution of maternal characteristics, such as cigarette smoking and advanced maternal age.
“However, decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness,” the researchers concluded.
The study is published in the Journal of the American Medical Association.
Source: JAMA and Archives Journals