Prenatal antidepressants don't raise fetal, baby death risk, study finds

Women who take certain antidepressants while pregnant do not raise the risk of a stillbirth or death of their baby in the first year of life, according to a large new study.

The findings stem from an analysis involving 30,000 women in Denmark, Finland, Iceland, Norway and Sweden, who gave birth to more than 1.6 million babies, in total, between 1996 and 2007. Close to 2 percent of the women took prescription selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine), for depressive symptoms during their pregnancy.

The research team, led by Dr. Olof Stephansson of the Karolinska Institute in Stockholm, Sweden, reports in the Jan. 2 issue of the Journal of the American Medical Association that initially women taking an SSRI for depression did seem to experience statistically higher rates of stillbirth and infant death. However, that uptick in risk disappeared once they accounted for other factors, including the threat posed by depression and the mother's history of psychiatric disease or hospitalizations, the authors noted in a journal news release.

"The present study of more than 1.6 million births suggests that SSRI use during pregnancy was not associated with increased risks of stillbirth, neonatal death or postneonatal death," Stephansson's team reported.

"The increased rates of stillbirth and postneonatal 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," the authors added.

Depression during pregnancy affects between 7 percent and 19 percent of mothers-to-be in economically developed countries, the authors pointed out in the report. "Maternal depression is associated with poorer pregnancy outcomes, including increased risk of preterm delivery, which in turn may cause neonatal morbidity and mortality," they explained.

The team acknowledged that use of SSRIs during pregnancy has been associated with birth defects, neonatal withdrawal syndrome and pulmonary hypertension of the newborn, which is what led to the current study, they said.

Although they found that the drugs posed no independent risk regarding stillbirth or infant death, the authors urged mothers and physicians to approach SSRI use carefully.

"Decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness," Stephansson and colleagues concluded.