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Outcomes of prenatal antidepressant exposure
Gregory E Simon1, Michael L Cunningham, Robert L Davis
1Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue #1600, Seattle, WA 98101, USA. simon.g@ghc.org
Insights
Prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) was linked to earlier delivery and lower birth weight, but not congenital malformations or developmental delays. Tricyclic antidepressant exposure showed no significant effects.
Area of Science:
- Perinatal Medicine
- Psychopharmacology
- Developmental Pediatrics
Background:
- Prenatal exposure to antidepressants is a concern for maternal-fetal health.
- Understanding the impact of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) on perinatal outcomes is crucial.
Purpose of the Study:
- To evaluate the effects of prenatal antidepressant exposure on perinatal outcomes, congenital malformations, and early growth and development.
- To compare outcomes between infants exposed to TCAs and SSRIs versus unexposed infants.
Main Methods:
- A group-model health maintenance organization cohort was used.
- Infants with prenatal TCA or SSRI exposure were frequency-matched to unexposed infants.
- Medical records were reviewed for perinatal outcomes, congenital malformations, and developmental delay.
Main Results:
- TCA exposure showed no significant differences in perinatal outcomes.
- SSRI exposure was associated with decreased gestational age and birth weight, and lower 5-minute Apgar scores.
- No significant associations were found between TCA or SSRI exposure and congenital malformations or developmental delay.
Conclusions:
- Prenatal SSRI exposure is associated with earlier delivery and lower birth weight.
- Third-trimester SSRI exposure may be linked to lower Apgar scores.
- The study found no evidence of increased risk for congenital malformations or developmental delay with prenatal TCA or SSRI exposure.
Objective:
This study evaluated the effects of prenatal antidepressant exposure on perinatal outcomes, congenital malformations, and early growth and development.
Method:
Within a group-model health maintenance organization, all infants with apparent prenatal exposure to tricyclic or selective serotonin reuptake inhibitor (SSRI) antidepressants were frequency matched to an unexposed comparison group by year of birth, maternal age, and mother's lifetime use of antidepressant drugs and mental health care. A structured blind review of mothers' and infants' medical records examined perinatal outcomes, congenital malformations, and developmental delay.
Results:
Tricyclic antidepressant exposure was not associated with any significant difference in perinatal outcomes. Exposure to SSRIs was associated with a 0.9-week decrease in mean gestational age, a 175-g decrease in mean birth weight, and a 0.29 decrease in mean Apgar score at 5 minutes, but differences in birth weights and Apgar scores were not significant after adjustment for gestational age. Differences in gestational age and birth weights were unrelated to length of exposure, but differences in Apgar scores were limited to those with third-trimester exposure. Neither tricyclic antidepressant nor SSRI exposure was significantly associated with congenital malformations or developmental delay.
Conclusions:
The authors found no association between tricyclic antidepressant or SSRI exposure and either congenital malformations or developmental delay. SSRI exposure during pregnancy was associated with earlier delivery and consequent lower birth weight. Third-trimester SSRI exposure was also associated with lower Apgar scores. Women considering taking SSRIs during pregnancy may balance any higher fetal risk against the risk of persistent or recurrent depression.