Antidepressant use during pregnancy linked to increased NICU admittance

1. Neonatal intensive care unit (NICU) admittance was higher among infants born to women receiving selective serotonin reuptake inhibitors (SSRIs) during pregnancy compared to nonexposed infants.

2. Maternal SSRI use during late pregnancy was associated with an increase in infant respiratory and CNS-related disorders, hypoglycemia, and feeding difficulties compared to SSRI use limited to early- and mid-pregnancy.

Evidence Rating Level: 2 (Good)

Study Rundown: SSRIs, including fluoxetine (Prozac) and sertraline (Zoloft), are commonly prescribed antidepressants. The consequences of untreated psychiatric illness during pregnancy are often thought to outweigh the risks of SSRI use; thus, SSRIs currently are not contraindicated during pregnancy. However, maternal SSRI use has been linked to several neonatal complications, including hypoglycemia, jaundice, and persistent pulmonary hypertension of the newborn. To investigate the severity of such complications and to tease apart the influence of SSRIs versus that of psychiatric illness, researchers performed a register-based analysis of singleton births in Sweden. Using NICU admission as a surrogate for severity of neonatal complications, results suggested that any use of SSRIs was associated with an increase in neonatal complications. With regard to neonatal morbidity, the authors were particularly interested in two comparisons: SSRI-exposure vs. no exposure and SSRI-exposure occurring within the last 90 days of pregnancy (late) vs. SSRI-exposure ceasing before that time period. Adjusted data were consistent with increased respiratory and CNS-related disorders and hypoglycemia with any SSRI exposure, with an additional increase in feeding difficulties for late SSRI use compared to early use only. Limitations of this study included its lack of accounting for severity of maternal illness and actual SSRI exposure, as prescriptions of SSRIs do not necessarily correspond to use. However, in the context of other reports consistent with these findings, clinicians may wish to reweigh the costs and benefits of continuing or initiating SSRIs in the 3rd trimester of pregnancy.

Click to read the study, published today in Pediatrics

Relevant Reading: Use of selective serotonin reuptake inhibitors during pregnancy

Study Author, Ulrika Nörby, MSc Pharm talks to 2 Minute Medicine: Department of E-health and Strategic IT, Health and Medical Care Administration, Stockholm County Council, Stockholm, Sweden.

“Newborn infants exposed to antidepressant drugs in utero had more complications and a higher rate of admissions to a NICU, in this large population-based study providing detailed information on neonatal diagnoses and interventions. The risk for severe neonatal illness was however low and should not prevent necessary treatment of depression and anxiety during pregnancy.”

In-Depth [retrospective cohort]: The Swedish Medical Birth Register and the Prescribed Drug Register for all singleton births in Sweden between July 1, 2006 and December 31, 2012 were used to divide the study population into 4 main groups: infants born to mothers receiving SSRIs at any time during or 1 month prior to pregnancy (any use), those born to mothers receiving SSRIs within the last 90 days of pregnancy with or without prior use (late use), those born to mothers only receiving SSRIs up until that time period (early use only), and those not listed (no use). Antidepressant use more broadly was also recorded. This information was linked to data on NICU admissions and neonatal diagnoses in the Swedish Neonatal Quality Register and Perinatal Revision South Register. In total, >700,000 births were included for analysis. After adjusting for maternal factors (e.g., maternal age and smoking habits) and fetal factors (gestational age [GA] and fetal weight for GA and sex), the odds ratio (OR) of NICU admission for any SSRI use was 1.5 (95% CI 1.4-1.5) relative to no antidepressant use. Comparing the neonatal outcomes between the early use only and late use groups suggested that SSRI use in the final 90 days of pregnancy increased the odds of infant respiratory and CNS-related disorders (OR 95% CIs: 1.2-1.6 and 1.2-3.0, respectively), hypoglycemia (OR 95% CI: 1.1-1.6), and feeding difficulties (OR 95% CI: 1.1-1.9). Although the analysis primarily focused on SSRIs, different classes of antidepressant medications were found to carry different risks for NICU admission.

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