SSRIs do not increase infant mortality risk

January 10, 2013

A recent study found no increased risk of stillbirth, neonatal death, or postneonatal death in infants born to women who used a selective serotonin reuptake inhibitor (SSRI) prescription during their pregnancies.

A recent study found no increased risk of stillbirth, neonatal death, or postneonatal death in infants born to women who used a selective serotonin reuptake inhibitor (SSRI) prescription during their pregnancies.

Although the use of SSRIs during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease is unknown, according to Olof Stephansson, MD, PhD, of the Karolinska Institutet, Stockholm, Sweden, and colleagues.

The authors obtained maternal characteristics, pregnancy, and neonatal outcomes from patient and medical birth registries of women from Denmark, Finland, Iceland, Norway, and Sweden to assess infant mortality risk associated with SSRIs at different periods from 1996 through 2007.

Among 1,633,877 singleton births, the authors noted 6,054 stillbirths, 3,609 neonatal deaths, and 1,578 postneonatal deaths. Nearly 30,000 (1.79%) women had filled a prescription for an SSRI during pregnancy, the researchers reported.

Although the authors found that women exposed to an SSRI had higher rates of stillbirth (4.62 vs. 3.69 per 1,000) and postneonatal death (1.38 vs. 0.96 per 1,000) than those who did not use SSRIs, the slightly elevated rates were attributed to factors such as the severity of the underlying psychiatric disease and maternal characteristics such as cigarette smoking and advanced maternal age.

"In multivariate models, SSRI use was not associated with stillbirth, neonatal death, or postneonatal death. Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease," the authors wrote.

The authors concluded that decisions about the use of SSRIs in pregnant women should take into account other perinatal outcomes and the risks associated with maternal mental illness.

The article was published Jan. 2 in The Journal of the American Medical Association.

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