The use of selective serotonin reuptake inhibitors in pregnancy.

OBJECTIVE: To provide an update of literature on the safety of using selective serotonin reuptake inhibitors (SSRIs) during pregnancy.

METHODS: MEDLINE was searched for English-language papers published from 1985 to 2003 on human studies of SSRIs, using the key words "serotonin reuptake inhibitors," "citalopram," "fluoxetine," "fluvoxamine," "paroxetine," and "sertraline."

RESULTS: The literature search yielded 12 338 publications. Previous studies on the safety of SSRIs in pregnancy were often based on small samples from medical centres, with heterogeneous design and outcome ascertainment methods, and had yielded inconsistent results. Consequently, the management of pregnant women with depression poses challenges to clinicians who are hesitant to prescribe anti-depression drugs, including SSRIs, because of concern about potential risks to the fetuses. Failure to adequately treat maternal depression can lead to progressively worsening depression that greatly compromises maternal-fetal health and can impair bonding and childcare in the postpartum period.

CONCLUSIONS: Because of the uncertainty regarding the safety of SSRI use during pregnancy, consultation with specialists experienced in treating depression may be helpful when treating pregnant women with SSRIs. Large-scale, population-based studies to comprehensively assess the safety of SSRIs in pregnancy are needed.