While there has been a great deal of attention paid to the risks of exposure to antidepressants, particularly the selective serotonin reuptake inhibitors (SSRIs), during pregnancy, there has been comparatively little information on the risk of stillbirth and infant mortality in this population.  In a recent population-based cohort study utilizing data from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden), researchers assessed the risk of stillbirth and infant mortality associated with the use of SSRIs during pregnancy.

Among the 1,633,877 women with singleton births included in the study, a total of 29,228 (1.79%) of mothers had filled a prescription for an SSRI during pregnancy.   SSRI exposure was not associated with stillbirth (adjusted odds ratio [OR], 1.17; 95% CI, 0.96-1.41; P = .12), neonatal death (adjusted OR, 1.23; 95% CI, 0.96-1.57; P = .11), or post-neonatal death (adjusted OR, 1.34; 95% CI, 0.97-1.86; P = .08). Estimates of risk were further attenuated when stratified by previous hospitalization for psychiatric disease.

Only two other studies have addressed the risk of stillbirth or infant mortality after prenatal SSRI exposure.  Kulin and colleagues did not observe any increase in risk of stillbirth among 267 women exposed to SSRIs.  In a larger study including 3703 Australian women, Colvin and colleagues reported no increase in risk of stillbirth but did find an increase in risk of death during the first year of life in the SSRI group (OR 1.8; 95% CI 1.3, 2.6); however, in this study they were not able to control for potential confounding variables, and it was unclear if this increase in risk of infant mortality among those exposed to SSRIs was due to prenatal exposure to SSRIs versus exposure to the underlying maternal psychiatric illness or other environmental factors such as smoking in the home.

The findings of the Nordic study are reassuring.  Among the nearly 30,000 women included in this study who used SSRIs during pregnancy, no significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or post-neonatal mortality.

Ruta Nonacs, MD PhD

Colvin L, Slack-Smith L, Stanley FJ, Bower C. Early morbidity and mortality following in utero exposure to selective serotonin reuptake inhibitors: a population-based study in Western Australia.  CNS Drugs. 2012;26(7):e1-e14.

Kulin NA, et al.  Pregnancy outcome following maternal use of the new selective serotonin reuptake inhibitors: a prospective controlled multicenter study.  JAMA. 1998;279(8):609-610.

Stephansson O, et al. Selective Serotonin Reuptake Inhibitors During Pregnancy and Risk of Stillbirth and Infant Mortality. JAMA. 2013 Jan 2;309(1):48-54.

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