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Prenatal SSRI Use Increases Risk of Preterm Birth
The prevalence of depression in the lives of women is estimated to be between 10 and 25 percent with increased vulnerability during childbearing years. A wealth of research has been published exploring the issues arising from issues with treating depression during pregnancy using a class of drugs known as selective-serotonin reuptake inhibitors (SSRI). These drugs are frequently dispensed as a first line treatment for affective disorders, even though SSRI’s cross the placental barrier and are present in amniotic fluid, calling into question their safety for babies in utero.
 A 2011 study published in The Journal of Affective Disorders looked into what effects prenatal exposure to SSRI antidepressants had on obstetrical and neonatal outcomes. Specifically, researchers hoped to learn whether SSRI treatment among pregnant women carried an increased risk for preterm birth. Studies have shown over the years that babies born preterm carry an elevated risk of developing autism.
The case control study looked at 252 pregnant women aged between 18 and 43 years old. All of the participants in the study visited the Perinatal Psychiatry Program between January 2004 and December 2008. A total of 84 pregnant women were diagnosed with affective disorder and exposed to SSRI’s. The other 168 women, the control group, did not have an active psychiatric disorder and were not exposed to SSRI treatment.
The results of the study showed that the women exposed to SSRIs during some point in their pregnancy showed a greater risk for preterm birth when compared to the women in the control group. According to the study, "women with depression or anxiety disorder who were treated with SSRI’s during pregnancy, mainly at a high dose, had lower gestational age and threefold increased risk of preterm birth as compared with women of similar age and parity with a current psychiatric diagnosis during pregnancy and who were non-exposed to antidepressants."
Importantly, the study also states that preterm birth is "associated with an increased risk of behavioral problems and impaired cognitive and academic performance at school age compared with infants born at term."
The authors of this study believe that the results point to a need to look long and hard at the decision to treat affective disorders with an SSRI. The decision to place a pregnant woman on SSRI antidepressant treatment must be "made carefully and with specific protocols which consider and control the risks for both mother and newborn. Researchers also point to interventions being needed to prevent preterm births among women taking SSRI's, especially those that have other risk factors for a preterm birth.
Summary Information
Title
Obstetrical and Neonatal Outcomes After Prenatal Exposure to Selective Serotonin Reuptake Inhibitors: The Relevance of Dose
Authors
A. Roca 1,2,3; Ll. Garcia-Esteve 1,5,6; M.L. Imaz 1,5; A. Torres 1; S. Hernandez 4; F. Botet 4,6; E. Gelabert 2;
S. Subira 2; A. Plaza 1; M. Valdez 5,6; R. Martin-Santos 5,6,7
- Perinatal Psychiatry Program, Institut Clinic of Neuroscience (ICN), Hospital Clínic, Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Department of Psychiatry, Consorci Sanitari de Terrassa, Barcelona, Spain
- Institut Clinic of Obstetrics, Gynecology and Neonatology (ICGON), Hospital Clínic, Barcelona, Spain
- Servei de Psiquiatria, Institut Clinic of Neuroscience (ICN), Hospital Clínic, Barcelona, Spain
- Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERSAM, Barcelona, Spain
Journal
The Journal of Affective Disorders, 2011 Dec;135(1-3):208-15. doi: 10.1016/j.jad.2011.07.022.
Epub 2011 Sep 3.
Funding
This study has been supported in part by grant FIS ISCIII (PI041880); the FIS had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
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