Safety of SSRIs in pregnancy

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A recent study, Jensen et al 2013 [1], sought to differentiate the effects of exposure to maternal depression from the effects of antidepressants in their contribution to a reduction of Apgar scores. They collected data regarding diagnosis of depression, use of antidepressants in pregnancy, and Apgar scores at 5 minutes from all pregnancies in Denmark from 1996 to 2006 using national databases. This gave information on 668,144 births. Pregnant women were divided into 8 risk groups depending on their exposure to antidepressants during pregnancy, their exposure to antidepressants before pregnancy, and a diagnosis of depression before the end of pregnancy. Logistic regression analyses were applied with Apgar score <7 as the outcome and risk group as the variable of interest. Apgar score of <7 at 5 minutes was used as the outcome because it has been associated with an increased risk of low IQ at age 18, individuals being less likely to have no income from work, and neurological disability [1].Mental health in pregnancy remains a significant issue, with 7-13% [1] of women experiencing depressive symptoms during pregnancy. ‘Confidential Enquiries into Maternal Deaths in the United Kingdom’ [2] have highlighted suicide in pregnancy and during the first postnatal year as a leading cause of maternal death. SSRIs are known to cross the placental barrier, however the safety of these drugs in pregnancy is not well understood [3]. In the NICE guidelines, the only documented risk regarding SSRIs in pregnancy (excluding paroxetine), is neonatal persistent pulmonary hypertension if antidepressants are taken after 20 weeks gestation. Previous studies have shown an association between pregnant women suffering from depression and taking antidepressants with low Apgar score in infants [1]. However, there is little evidence whether this association is attributable to antidepressants or the depressive illness.
Original languageEnglish
JournalCambridge Medicine Journal
Publication statusPublished (in print/issue) - 24 Jul 2013


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