The use of selective serotonin reuptake inhibitors (SSRIs) to treat maternal psychiatric disorders is linked to a lower risk of preterm birth and a Cesarean section delivery, but a higher risk of neonatal problems. Study findings are published in the American Journal of Psychiatry.

Researchers from Columbia University, along with colleagues in Finland, studied single births in 1996–2010 (n=845,345) from the Finnish Medical Birth Register, as well as data from national registers on prescription drug purchases, mothers’ psychiatric history, maternal medical history, hospital sources, and healthcare professionals. The subjects were classified as SSRI users, those with a psychiatric diagnosis related to SSRI use but no antidepressant purchases, and those without a diagnosis or antidepressant purchases, to assess whether outcomes were due to maternal underlying psychiatric disorder or due to drug use. In the study, a total of 12,817 women had bought SSRIs during the first trimester, and almost 60% (n=9,322) made two or more purchases.

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The study found that the risk of preterm birth was 16% lower and the risk of very preterm birth was almost 50% lower in women using the antidepressants during pregnancy vs. women with a psychiatric diagnosis that did not use medication. Maternal psychiatric illness without medication use was linked to an increased risk of Cesarean section vs. those without a diagnosis or antidepressant purchase (26.5% vs. 17%). Researchers also saw a small increase in the risk of bleeding during or after delivery for women with a diagnosis but in the no-medication group vs. those without a diagnosis or antidepressant purchase (3.5% vs. 3%). SSRI use was associated with a greater risk of all neonatal problems that resulted in longer hospitalization and neonatal care.

These findings suggest that taking these antidepressants is tied to a lower risk of preterm birth and Cesarean section but also confirm previous findings of a higher risk of some neonatal complications. Prescribing these medications during pregnancy should be based on the mother’s medical and psychiatric history, study authors concluded.

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