Link between SSRI use in pregnancy and stillbirth refuted

Jan 3 2013

By Caroline Price, Senior medwireNews Reporter

Study findings suggest that use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy does not pose any increased infant mortality risk.

Researchers found no association between SSRI use during pregnancy and the risk for stillbirth, neonatal mortality, or postneonatal mortality among women with single births, once maternal factors such as advanced age, cigarette smoking, and increased severity of the underlying psychiatric disease were taken into account.

Depression during pregnancy is common and associated with poorer pregnancy outcomes, explains the team, led by Olof Stephansson (Karolinska University Hospital, Stockholm, Sweden).

Some evidence suggests that SSRI use during pregnancy may be associated with poor birth outcomes, such as congenital abnormalities and spontaneous abortion. Any potential association with stillbirth and infant mortality, particularly when accounting for the mother's history of mental illness, has been less studied, they write.

Here, the researchers studied women with single births during various periods between 1996 and 2007 in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden).

As reported in the Journal of the American Medical Association, this amounted to a total of 1,633,877 singleton births, among which there were 6054 stillbirths, 3609 neonatal deaths, and 1578 postneonatal deaths.

A total of 29,228 (1.79%) women filled a prescription for an SSRI during pregnancy. These women had higher rates of stillbirth and postneonatal death than those who did not, at respective rates of 4.62 versus 3.69 and 1.38 versus 0.96 per 1000, while neonatal deaths occurred at similar rates in each group, at 2.54 and 2.21 per 1000.

However, in multivariable analysis accounting for maternal characteristics, country, and year of birth there was no longer any association between SSRI exposure and stillbirth or postneonatal death, at odds ratios of 1.17 (95% confidence interval [CI]: 0.96-1.41) and 1.34 (95% CI: 0.97-1.86), respectively.

Moreover, the adjusted odds for all the outcomes were attenuated after stratifying by previous hospitalization for psychiatric disease.

For instance, among women previously hospitalized with psychiatric illness the odds ratio for stillbirth was 0.92 (95% CI: 0.66-1.28), compared with 1.07 (95% CI: 0.84-1.36) among those who were not.

The corresponding nonsignificant odds ratios for neonatal death were 0.89 and 1.14, and for postneonatal death 1.02 and 1.10.

The authors nevertheless caution: "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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