There have been many questions and concerns surrounding depression and SSRI (selective serotonin reuptake inhibitor) drugs during pregnancy. While researchers have found, through previous studies, that there is a higher risk for some conditions, there are still some unknowns when it comes to SSRI use during pregnancy. But for that matter, there are still some questions about how depression itself can affect the overall pregnancy outcome. And because depression is so common in the general population, it seems that answers need to be found, and soon.
“Depression during pregnancy is common with prevalences ranging between 7 percent and 19 percent in economically developed countries. Maternal depression is associated with poorer pregnancy outcomes, including increased risk of preterm delivery, which in turn, may cause neonatal morbidity,” Researchers on a recent study from Stockholm Sweden said in their report, which was published in the medical journal, JAMA. “Use of selective serotonin reuptake inhibitors during pregnancy has been associated with congenital anomalies, neonatal withdrawal symptoms, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown.”
Led by Olof Stephansson, M.D., Ph.D., of the Karolinska Institutet, Sweden, a team of experts set out to answer this one question – they wanted to know if women taking SSRIs during pregnancy had a higher risk of delivering a stillborn baby or if their babies had a higher chance of morbidity shortly after birth.
To find the answer, the team observed information on 1,633,877 women who had had single births between 1996 and 2007. Information on the SSRI use of these women was found by accessing prescription registries and information on the pregnancy, mother’s characteristics and neonatal outcomes were found by accessing patient and birth medical registries.
After examining the information, the team found 3,609 neonatal deaths – 1,578 postnatal deaths and 6,054 stillbirths. Exactly 1.79% (29,228) of the women included in the study took SSRIs during pregnancy. Researchers also adjusted the data to account for the effects that prior psychiatric hospitalization and maternal characteristics may have had on pregnancy outcomes.
Overall, researchers found that women who had taken SSRIs during pregnancy had a higher rate of stillbirths (4.62 vs. 3.69 per 1,000) and postneonatal deaths (1.38 vs. 0.96 per 1,000) when compared to subjects not exposed. After accounting for certain variables, researchers found that those on SSRIs did not have a higher risk of stillbirth or postnatal death.
“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 study authors said. “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.”
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