The Swedish study of more than 1.6m births in five Nordic countries included nearly 30,000 women who had filled in a prescription for an SSRI (selective serotonin reuptake inhibitor) during pregnancy.
The researchers found that the 1.79% of mothers exposed to an SSRI had higher rates of stillbirth (4.62 versus 3.69 per 1,000) and postneonatal death (1.38 versus 0.96 per 1,000) than those who did not.
But the slightly higher rates were attributed to the severity of the underlying psychiatric disease — usually depression — rather than its treatment.
Smoking and the mother’s advanced age were also linked to higher deaths. Mothers exposed to an SSRI and those who were not had a similar rate of neonatal death (2.54 versus 2.21 per 1000).
Among the total surveyed group there were 1,633,877 single births, 6,054 stillbirths, 3,609 neonatal deaths, and 1,578 postneonatal deaths.
The study “suggests that SSRI use during pregnancy was not associated with increased risks of stillbirth, neonatal death, or postneonatal death,” said authors of the research led by Olof Stephansson of the Karolinska Institutet in Stockholm.
“However, decisions regarding use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness.”
A US-based expert expressed concern at the findings, published in The Journal of the American Medical Association.
“This study looked at information on dispensed drugs, not ingested drugs, and these numbers are often quite different,” Adam Urato, assistant professor of obstetrics and gynaecology at Tufts University School of Medicine, told WebMD medical news.
“I don’t find the study results particularly reassuring.”
The women included in the study were from Denmark, Finland, Iceland, Norway, and Sweden. The data covered different periods from 1996 through 2007.
Researchers obtained information on the use of antidepressants from prescription registries, while patient and medical birth registries provided the data for maternal characteristics, pregnancy and neonatal outcomes.
Between 7% and 19% of women suffer from depression during pregnancy, according to background information in the study.
The use of SSRIs during pregnancy has long been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn.