Selective Serotonin Reuptake Inhibitor Exposure In Utero and Pregnancy Outcomes

Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau.
JAMA Pediatrics (Impact Factor: 5.73). 10/2009; 163(10):949-54. DOI: 10.1001/archpediatrics.2009.164
Source: PubMed


To investigate the effect of intrauterine selective serotonin reuptake inhibitor (SSRI) exposure on pregnancy outcomes.
Prospective cohort study.
Department of Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
Pregnant women receiving prenatal care in our hospital from 1989 to 2006.
Maternal SSRI use during pregnancy.
Gestational age, birth weight, head circumference, 5-minute Apgar score, and admission to the neonatal intensive care unit.
Three hundred twenty-nine pregnant women reported treatment with SSRIs, 4902 were not treated with SSRIs but had a history of psychiatric illness, and 51 770 reported no history of psychiatric illness. Gestational age was 5 days (95% confidence interval [CI], -6 to -3) shorter and the odds ratio (OR) for preterm birth was 2.0 (95% CI, 1.3-3.2) in the women exposed to SSRIs compared with women with no history of psychiatric illness. In utero-exposed newborns had increased risk of admission to the neonatal intensive care unit (OR, 2.4; 95% CI, 1.7-3.4) and of 5-minute Apgar scores of less than 8 (OR, 4.4; 95% CI, 2.6-7.6) compared with those not exposed. Head circumference and birth weight did not differ between infants in the exposed and unexposed groups. The results were similar when compared with infants of women with a psychiatric history.
Exposure to SSRIs during pregnancy was associated with an increased risk of preterm delivery, a low 5-minute Apgar score, and neonatal intensive care unit admission, which was not explained by lower Apgar scores or gestational age. The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants.

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    • "Sensitivity was assumed to be 26 %, the level expected if true SSRI exposure prevalence was 3 % and observed exposure prevalence was 0.7 %. A similar approach was used to examine the impact of under-ascertainment of maternal depression because published estimates of the prevalence of maternal depression during pregnancy in Europe range from 3 to 17 % (Evans et al. 2001; Josefsson et al. 2001; Lund et al. 2009; Olsen et al. 2004)—much higher than our observed prevalence of 0.6 %. In our simulations, we increased maternal depression prevalence to 5 % and then 15 %, and assumed this to be non-differential with respect to ASD case status. "
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    ABSTRACT: We investigated whether there is an association between increased risk for autism spectrum disorders (ASD) and selective serotonin reuptake inhibitors (SSRIs) used during pregnancy. This study used Denmark's health and population registers to obtain information regarding prescription drugs, ASD diagnosis, and health and socioeconomic status. There were 1.5 % of cases and 0.7 % of controls exposed to SSRIs during the pregnancy period, and higher effect estimates observed with longer use. We found evidence that in utero exposure to SSRIs increases a child's risk associated with ASD. These results, while adding to the limited knowledge on prenatal pharmacological exposures as potential ASD risk factors, need to be balanced against the benefits of indicated medication use by pregnant mothers.
    Journal of Autism and Developmental Disorders 05/2014; 44(10). DOI:10.1007/s10803-014-2128-4 · 3.06 Impact Factor
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    • "4.52 (0.47–43.41) 9 Yes Reis [24] 2010 SSRI Mixed Retrospective 1068177 1.13 (0.97–1.31) 1.45 (1.31–1.63) 6 No Lund [25] 2009 SSRI Nondepressed Prospective 52099 0.63 (0.15–2.67) 2.02 (1.29–3.16) 7 No Toh [26] 2009 SSRI Mixed Retrospective 5796 1.27 (0.59–2.76) 8 No Wisner [27] 2009 SSRI Nondepressed Prospective 179 5.43 (1.98–14.84) "

    General hospital psychiatry 01/2014; 36(3). DOI:10.1016/j.genhosppsych.2014.01.005 · 2.61 Impact Factor
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    • "4.52 (0.47–43.41) 9 Yes Reis [24] 2010 SSRI Mixed Retrospective 1068177 1.13 (0.97–1.31) 1.45 (1.31–1.63) 6 No Lund [25] 2009 SSRI Nondepressed Prospective 52099 0.63 (0.15–2.67) 2.02 (1.29–3.16) 7 No Toh [26] 2009 SSRI Mixed Retrospective 5796 1.27 (0.59–2.76) 8 No Wisner [27] 2009 SSRI Nondepressed Prospective 179 5.43 (1.98–14.84) "
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    ABSTRACT: To examine the relationship between antidepressant use in pregnancy and low birth weight (LBW) and preterm birth (PTB). We searched English and non-English language articles via PubMed, CINAHL and PsychINFO (from their start dates through December 1st, 2012). We used the following keywords and their combinations: antidepressant, selective serotonin reuptake inhibitor (SSRI), pregnancy, antenatal, prenatal, birthweight, birth weight, preterm, prematurity, gestational age, fetal growth restriction, intrauterine growth restriction, and small-for-gestational age. Published studies were considered eligible if they examined exposure to antidepressant medication use during pregnancy and reported data on at least one birth outcome of interest: PTB (<37 weeks gestation) or LBW (<2500 g). Of the 222 reviewed studies, 28 published studies met the selection criteria. Two authors independently extracted study characteristics from eligible studies. Using random-effects models, antidepressant use in pregnancy was significantly associated with LBW (RR: 1.44, 95% confidence interval (CI): 1.21-1.70) and PTB (RR: 1.69, 95% CI: 1.52-1.88). Studies varied widely in design, populations, control groups and methods. There was a high level of heterogeneity as measured by I2 statistics for both outcomes examined. The relationship between antidepressant exposure in pregnancy and adverse birth outcomes did not differ significantly when taking into account drug type (SSRI vs. other or mixed) or study design (prospective vs. retrospective). There was a significant association between antidepressant exposure and PTB for different types of control status used (depressed, mixed or nondepressed). Antidepressant use during pregnancy significantly increases the risk for LBW and PTB.
    General hospital psychiatry 10/2013; 36(1). DOI:10.1016/j.genhosppsych.2013.08.002 · 2.61 Impact Factor
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