Antidepressants linked to premature birth risk

What do we know already?

More than one in 10 women become depressed during pregnancy. In cases where doctors recommend drug treatment, the first choice is often a selective serotonin reuptake inhibitor (SSRI).

Doctors are advised that pregnant women should take SSRIs ‘only if potential benefit outweighs risk’. Unfortunately, there’s little research on how safe these drugs are during pregnancy. We do know that SSRIs get into the unborn baby’s bloodstream, and that some babies get withdrawal symptoms soon after birth. Some research also suggests that babies may be more at risk of heart defects if their mother takes an SSRI called paroxetine in the first three months of pregnancy.

A new study has looked at 329 women who were taking SSRIs while pregnant. The health of their babies was compared with the health of babies born to women not taking antidepressants. Some of the women in this latter group had mental health problems, while others did not.

What does the new study say?

Women taking an SSRI had twice the risk of a premature birth. On average, women gave birth four or five days sooner if they took an SSRI while pregnant. But the results don’t tell us the actual numbers of women in each group who gave birth prematurely, so we can’t say what the actual risk is.

About 16 in 100 babies needed treatment in an intensive care unit if their mother had taken an SSRI, compared with seven in 100 babies whose mothers were healthy, and nine in 100 babies whose mothers had a mental health problem but who weren’t taking an SSRI.

Babies also appeared less healthy overall if their mother had taken an SSRI. This was measured looking at their skin colour, how much they moved about, their pulse rate and breathing, and how much they responded to stimulation.
SSRIs didn’t increase the risk of having an underweight baby. The study only looked at what happened around birth, so we don’t know whether or not SSRIs have longer-term consequences.

What does this mean for me?

The study suggests that, in the short term at least, there could be some negative consequences to taking SSRIs while pregnant. What the research doesn’t tell us is how the risks of SSRIs in pregnancy compare with the dangers of untreated depression.

Depression itself can affect how babies grow. It can also cause unpleasant symptoms for the mother. There’s a high chance of becoming depressed again when women stop taking antidepressants when they’re pregnant. So, we can’t simply say that pregnant women should completely avoid SSRIs.

How reliable are the findings?

This is a fairly good study. Since it also included a group of women who had mental health problems but who were not taking an SSRI, we can partly rule out the possibility that mental health issues affected the baby’s health rather than antidepressants. However, it could still be that women taking SSRIs were more seriously depressed than the women they were compared with, or that they had worse overall health. This factor might have affected the health of the babies, and it makes the study less reliable.

Where does the study come from?

The women who took part in the research all had antenatal care at a hospital in Aarhus, Denmark. The study appeared in a journal called Archives of Pediatrics & Adolescent Medicine, published by the American Medical Association. Some of the funding came from the Danish Medical Research Council.

What should I do now?

If you’re pregnant and taking an antidepressant, don’t stop treatment suddenly. You could put yourself at risk of unpleasant withdrawal symptoms, and your depression could come back. Your doctor can help you weigh up the risks and benefits of treatment. If you and your doctor decide it’s the right thing to do, you’ll need to come off your medicine gradually.

If you’re taking antidepressants and you want to get pregnant, talk to your doctor. Depending on how severe your depression is, your doctor might suggest slowly coming off your medicine, or continuing to take it.