Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes

Hanan El Marroun, Vincent W V Jaddoe, James J Hudziak, Sabine J Roza, Eric A P Steegers, Albert Hofman, Frank C Verhulst, Tonya J H White, Bruno H C Stricker, Henning Tiemeier
Archives of General Psychiatry 2012, 69 (7): 706-14

CONTEXT: Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to pregnant women, but knowledge about their unintended effects on child health is scarce.

OBJECTIVE: To examine the effects of maternal SSRI use during pregnancy on fetal growth and birth outcomes.

DESIGN: The study was embedded in the Generation R Study, a prospective population-based study from fetal life onward.

PARTICIPANTS: Seven thousand six hundred ninety-six pregnant women were included. Selective serotonin reuptake inhibitor use was assessed by questionnaires in each trimester and verified by pharmacy records. Using depressive symptom scores from the Brief Symptom Inventory, 7027 pregnant mothers (91.3%) had no or low depressive symptoms, 570 pregnant mothers (7.4%) had clinically relevant depressive symptoms and used no SSRIs, and 99 pregnant mothers (1.3%) used SSRIs.

MAIN OUTCOME MEASURES: Fetal ultrasonography was performed in each trimester. We determined fetal body and head growth with repeated assessments of body and head size. The birth outcomes studied were preterm birth, small for gestational age, and low birth weight.

RESULTS: Fetuses from mothers with prenatal depressive symptoms showed reduced body growth (β=-4.4 g/wk; 95% CI: -6.3 to -2.4; P<.001) and head growth (β=-0.08 mm/wk; 95% CI: -0.14 to -0.03; P=.003). Mothers using SSRIs during pregnancy had fewer depressive symptoms than mothers in the clinical symptom range. Prenatal SSRI use was not associated with reduced body growth but was associated with reduced fetal head growth (β=-0.18 mm/wk; 95% CI: -0.32 to -0.07; P=.003). The SSRI-exposed children were at higher risk for preterm birth (odds ratio=2.14; 95% CI: 1.08 to 4.25; P=.03).

CONCLUSIONS: Untreated maternal depression was associated with slower rates of fetal body and head growth. Pregnant mothers treated with SSRIs had fewer depressive symptoms and their fetuses had no delay in body growth but had delayed head growth and were at increased risk for preterm birth. Further research on the implications of these findings is needed.

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