Women who take selective serotonin reuptake inhibitors (SSRIs) in early pregnancy have a small but significantly greater risk of having stillbirths or babies born with major congenital birth defects, compared to women who do not take these antidepressants, according to a new study led by researchers at Swansea University in the U.K.
The study analyzed data from more than 500,000 infants in Wales, Norway and Denmark. It found that women who had been prescribed SSRIs in the first trimester of pregnancy or three months before pregnancy were at a small but significantly greater risk of having infants with congenital anomalies, particularly severe heart defects or stillbirths compared with those who did not take SSRIs.
The findings show that in women who did not take SSRIs, six in 200 pregnancies had an adverse outcome of stillbirth or a baby with a major congenital anomaly, but when SSRIs were prescribed this rose to seven in 200. The researchers say this risk is of public health importance due to the severity of the outcome and because SSRIs are prescribed to many pregnant women.
“To our knowledge, this is the first dose-response analysis that shows the link between SSRI doses and congenital anomalies and stillbirths. While this extra risk may seem small, in my view, the outcomes are as serious as they can be,” said study leader Professor Sue Jordan at the College of Human and Health Sciences.
“Women should not stop taking SSRIs without consulting their doctors, and we are not saying stop all medicines, but our message is that we want our health care professionals to be very mindful of this link and to take the appropriate action to ensure that women are given the right type of care before, during and after pregnancy to minimize the risks of congenital anomalies and stillbirths linked to SSRIs.”
Professor Helen Dolk, who led the EUROmediCAT project, added that “Women should not stop taking SSRIs without discussing with their doctor the benefits and risks of SSRIs and alternative nonpharmacological therapies, since good mental health is important for both mother and child.”
Finally, the researchers are calling on health care professionals to closely review all women requesting SSRI prescriptions and not just those who are planning pregnancy. They also suggest that health care workers evaluate pre-pregnancy care when SSRIs are prescribed and consider offering at-risk women enhanced scans to detect serious heart defects.
The findings are published in the the journal PLOS ONE.
Source: Swansea University