Using antidepressant medication during pregnancy is linked to higher risk of preterm birth and newborn respiratory distress, according to a new study.
Roughly 7% to 13% of pregnant women use antidepressants, but previous studies have reached different conclusions about their impact on infants. In this study, authors aimed to look at the dose and timing of antidepressant use.
Data on about 226,932 infants showed 15,041 (6.6%) were exposed to antidepressants, the most common of which was sertraline. Mothers’ antidepressant use was categorized in one of five ways — low, low sustained, moderate, moderate sustained and high sustained, which are detailed in “Prenatal Antidepressant Use and Risk of Adverse Neonatal Outcomes,” (Bandoli G, et al. Pediatrics. June 8, 2020, https://doi.org/10.1542/peds.2019-2493).
Researchers looked for links to cardiac malformations, preterm birth and newborn respiratory distress by comparing the odds of these three conditions in the group with the lowest use as well as those with anxiety or depression who were not taking medications to the other groups using antidepressants.
Each group had a greater risk for neonatal respiratory distress than the lowest use group (adjusted risk ratios of 1.23 to 2.23) and those with anxiety or depression who weren’t using medications.
Authors said increased serotonin in the fetus may have had an impact on the maturity of the infant’s respiratory system or the ability to adapt to the environment outside the uterus. The respiratory distress also could have been due to acute selective serotonin reuptake inhibitor withdrawal.
Results also showed infants whose mothers had moderate sustained or high sustained antidepressant use during pregnancy were at increased risk of preterm birth (adjusted risk ratios of 1.31 and 1.78, respectively). Moderate sustained use also was associated with an increased risk of major cardiac malformations compared to the low use group. However, a comparison to the untreated group called into question whether a link really exists.
The study was limited by not knowing if women were taking their antidepressants as prescribed and if other factors were at play such as smoking, alcohol use or obesity. Authors also did not know how severe anxiety and depression was for those not taking medication.
Leaving maternal depression untreated carries its own risks to both the mother and her fetus. The authors said “findings support continuation of the lowest effective dose to treat depression or anxiety” and that more studies should be done taking into account different patterns of antidepressant use.
Authors of a related commentary said while the study was thorough, it also highlights the need for larger databases to perform these studies.
“Because in utero and early childhood experiences provide the foundation for long-term health, it is imperative that we generate better information about the impact of medication exposures on infant and child outcomes,” they wrote. “To do so will require investing in research that fosters new collaborations and innovative approaches, with the potential payoff being new knowledge that will improve the health and well-being of future generations of children.”
