More questions on antidepressants during pregnancy

When moms-to-be use antidepressants, their babies may be more likely to be born early or have a seizure soon after birth, a large U.S. study suggests.

The findings, reported in the American Journal of Obstetrics & Gynecology, add to evidence linking antidepressants to certain pregnancy risks - including preterm birth and smaller size at birth.

Experts are not sure if the medications, themselves, are to blame.

But in general, they say the safest course is to stop using antidepressants during pregnancy, if possible.

In the new study, researchers found that among nearly 229,000 infants born to Tennessee women, those whose moms used antidepressants during their second trimester tended to be born earlier.

When mothers filled two or three antidepressant prescriptions during the second trimester, their babies stayed in the womb for four to five days less, on average, than other babies.

In addition, newborns were more likely to have a seizure if their mother used a selective serotonin reuptake inhibitor (SSRI) during the third trimester.

SSRIs include commonly used antidepressants such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil).

Newborn seizures are uncommon, however - so even with a relative increase in risk, the risk to any one baby is very small, said Dr. Richard C. Shelton, one of the researchers on the new study.

On top of that, such seizures seem to cause no long-term damage.

Maternal antidepressant use and adverse outcomes: a cohort study of 228,876 pregnancies

Results

Of 23,280 pregnant women with antidepressant prescriptions prior to pregnancy, 75% filled none in the second or third trimesters of pregnancy and 10.7% used antidepressants throughout pregnancy. Filling 1, 2, and 3+ antidepressants during second trimester was associated with shortened gestational age by 1.7 (1.2- 2.3), 3.7 (2.8- 4.6), and 4.9 (3.9- 5.8) days, controlling for measured confounders. Third trimester selective serotonin reuptake inhibitor (SSRI) use was associated with infant convulsions; adjusted odds ratios were 1.4 (0.7-2.8); 2.8 (1.9- 5.5); and 4.9 (2.6-9.5) for filling 1, 2, and 3 prescriptions respectively.

Conclusions

Most women discontinue antidepressant medications prior or during the first trimester of pregnancy. Second trimester antidepressant use is associated with preterm birth, and third trimester SSRI use is associated with infant convulsions.

Rachel M. Hayes, PhD,
Pingsheng Wu, PhD,
Richard C. Shelton, MDemail,William O. Cooper, MD, MPH,William D. Dupont, PhD,Ed Mitchel, BS,Tina V. Hartert, MD, MPH