No significant link between stillbirth and maternal antidepressant use

Certain maternal characteristics can account for increased deaths seen with SSRI use

Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy is not associated with an increased risk of stillbirths, neonatal deaths, or post-neonatal deaths after taking certain maternal characteristics into account, according to a study published in the Journal of the American Medical Association.

Olof Stephansson, MD, PhD, from the Karolinska Institutet in Stockholm, Sweden, and colleagues examined the risk of stillbirths and infant mortality among 1,633,877 singleton births from the five Nordic countries, where 29,228 births were to mothers who had filled a prescription for an SSRI during pregnancy.

The researchers found that, overall, there were 6,054 stillbirths; 3,609 neonatal deaths; and 1,578 post-neonatal deaths. In unadjusted analysis, there were significantly higher rates of stillbirth and post-neonatal death, but not neonatal death, for women exposed to SSRIs. After adjustment for maternal characteristics, country, and year of birth, the association was no longer significant for SSRI use and stillbirth (odds ratio [OR], 1.17; P = 0.12); neonatal death (OR, 1.23; P = 0.11); or post-neonatal death (OR, 1.34; P = 0.08). Adjusting for previous hospitalization for psychiatric disease further attenuated the ORs for stillbirth, neonatal death, and post-neonatal death (ORs, 0.92, 0.89, and 1.02, respectively, for women who were hospitalized versus 1.07, 1.14, and 1.10, respectively, for women who were not).

“The increased rates of stillbirth and post-neonatal 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,” Stephansson and colleagues write.

The study was partially funded by the Swedish Pharmacy Company.

To read the abstract of “Selective Serotonin Reuptake Inhibitors During Pregnancy and Risk of Stillbirth and Infant Mortality,” click here.

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