New Study Reveals Both Benefits and Risks of Antidepressants During Pregnancy

Treating maternal psychiatric disorder with commonly used antidepressants is associated with a lower risk of certain pregnancy complications including preterm birth and delivery by Caesarean section, according to researchers at Columbia University’s Mailman School of Public Health, Columbia University Medical Center, and the New York State Psychiatric Institute. However, the medications—selective serotonin reuptake inhibitors, or SSRIs—resulted in an increased risk of neonatal problems. Findings are published online in the American Journal of Psychiatry.

“To our knowledge, the association between taking antidepressants in pregnancy and a lower risk of preterm birth is a novel finding,” said Alan Brown, MD, MPH, professor of Psychiatry and Epidemiology and senior author. “Up to now, studies which were based on maternal underlying psychiatric illness had small sample sizes and reported inconsistent results.”

The Columbia researchers with colleagues in Finland studied 845,345 single births in 1996 through 2010 from the Finnish Medical Birth Register. They also analyzed data from national registers on prescription drug purchases, mothers’ psychiatric history, maternal medical history, hospital sources, and healthcare professionals. The women were categorized into mutually exclusive groups: SSRI users, those with a psychiatric diagnosis related to SSRI use but no antidepressant purchases, and those without a diagnosis or antidepressant purchases, to determine if outcomes were a result of maternal underlying psychiatric illness or due to use of the drugs.

This class of antidepressants is the most commonly used for treating depression and anxiety during pregnancy, with 4-10% of pregnant women prescribed them in Finland and in the U.S. A total of 12,817 women in the study had purchased the antidepressants during the first trimester or 30 days before the beginning of gestation, and 9,322 (59%) made two or more purchases.

The risk of preterm birth was 16% lower, and the risk of very preterm birth nearly 50% lower in women using the antidepressants during pregnancy compared to mothers with a psychiatric diagnosis but no medication use. Preterm birth is the most important single cause of neonatal and infant death and is associated with long-term neurological disabilities in the surviving infants.

Maternal psychiatric disorder without medication use was associated with an increased risk of Caesarean section (26.5 percent) compared to those without a diagnosis or antidepressant purchases (17 percent). There was a slightly greater risk of bleeding during or after delivery (3.5 percent) for women with a diagnosis but in the no-medication group as compared to those without a diagnosis or anti-depressant purchases (3 percent).

While the risk of being born small for gestational age did not differ for the babies of mothers with or without antidepressant drug treatment, SSRI use was associated with an increased risk of all neonatal problems, including breathing issues, that led to longer hospital stays and neonatal care.

“Our findings provide evidence that taking these antidepressants is associated with a lower risk of preterm birth and Caesarean section and further confirm the results from previous research of a higher risk for several neonatal problems,” noted Brown. “Given these divergent findings, the decision whether to prescribe these medications during pregnancy should be individualized to the mother’s medical and psychiatric history.”

The study was funded by NIH Grant P50MH090966 and the Sigrid Juselius Foundation, the Foundation for Pediatric Research in Finland and the Finnish Medical Foundation. The authors report no competing interests.

About Columbia University’s Mailman School of Public Health

Founded in 1922, Columbia University’s Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master’s and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including ICAP (formerly the International Center for AIDS Care and Treatment Programs) and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

Columbia University Department of Psychiatry & New York State Psychiatric Institute

Columbia Psychiatry is ranked among the best departments and psychiatric research facilities in the nation and has contributed greatly to the understanding and treatment of psychiatric disorders. Located at the New York State Psychiatric Institute on the NewYork-Presbyterian Hospital/Columbia University Medical Center campus in Washington Heights, the department enjoys a rich and productive collaborative relationship with physicians in various disciplines at Columbia University’s College of Physician’s and Surgeons. Columbia Psychiatry is home to distinguished clinicians and researchers noted for their clinical and research advances in the diagnosis and treatment of depression, suicide, schizophrenia, bipolar and anxiety disorders, eating disorders, and childhood psychiatric disorders. Visit http://columbiapsychiatry.org/ and http://nyspi.org for more information.