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Related Experiment Video

Updated: Jul 14, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Published on: August 25, 2014

Neonatal Outcomes Following Selective Serotonin Reuptake Inhibitor Use During Pregnancy.

Layla Aref1, Jacob J Hughey1, Sherwin Shirazi1,2,3

  • 1Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.

JAMA Network Open
|July 13, 2026
PubMed
Summary

Selective serotonin reuptake inhibitor (SSRI) continuation during pregnancy showed lower Apgar scores and increased meconium-stained fluid. However, SSRI use did not significantly increase risks for major complications or NICU admissions in newborns.

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Published on: June 13, 2021

Area of Science:

  • Perinatal medicine
  • Pharmacology
  • Neonatology

Background:

  • Evaluating selective serotonin reuptake inhibitor (SSRI) safety in pregnancy is complex due to ethical and methodological challenges.
  • Observational studies often face confounding factors, limiting causal inference regarding SSRI use and neonatal outcomes.

Purpose of the Study:

  • To compare neonatal outcomes between pregnancies with selective serotonin reuptake inhibitor (SSRI) continuation and discontinuation.
  • To utilize a target trial framework to emulate randomized controlled trials for improved causal inference in pregnancy medication safety.

Main Methods:

  • A cohort study emulating target trials using linked electronic health records of mothers and neonates.
  • Two trials were conducted: periconception (congenital anomalies) and early-pregnancy (non-anomaly outcomes).
  • Included singleton pregnancies (2006-2022) with pre-conception SSRI use and first-trimester prenatal visits.

Main Results:

  • SSRI continuation was linked to lower Apgar scores at 1 and 5 minutes (MD -0.39 and -0.28, respectively).
  • An increased risk of meconium in amniotic fluid was observed with SSRI continuation (OR 1.73).
  • No significant associations were found for congenital anomalies, NICU admission, or other assessed outcomes.

Conclusions:

  • Selective serotonin reuptake inhibitor (SSRI) continuation during pregnancy is associated with impaired neonatal adaptation, specifically lower Apgar scores and meconium-stained fluid.
  • The study did not find significant associations between SSRI continuation and severe neonatal complications or NICU admission.
  • Target trial emulation enhances causal inference in medication safety studies during pregnancy, emphasizing careful comparator selection.