Are antidepressants safe for use in pregnancy?

The BJOG have published three studies into the long term effects of women taking antidepressants during pregnancy, which together have indicated that their use has no long-term negative neurodevelopmental or behavioural effects on the child, but that they do increase the risk of significant blood loss during childbirth.

The research from the Norwegian Institute of Public Health examined the effects that selective serotonin reuptake inhibitors (SSRIs) have on the child’s motor skill development at three years old, comparing results from mother’s who’d had prolonged use of SSRIs to those who had not used them at all.  The results indicated a slight association between SSRI use and a delayed motor development at age three, however, only a very small number of children had a severe delay. Researchers acknowledged that they also lacked complete information on the severity of the maternal depression in the different groups, which may have had an impact on the results.

In the second study, an Australian team analysed data from the Danish National Birth Cohort, to investigate the impact of prenatal exposure to SSRIs on behavioural problems at aged 7. It found that those whose mothers had had untreated prenatal depression had an increased risk of problem behaviour in the children such as hyperactivity, inattention, and peer problems.

Marte Handal, lead author of the first study said: “Effective treatment of depression during pregnancy is essential and these results should not discourage healthcare professionals from prescribing or continuing antidepressant treatment to those who need it.”

The third study was also conducted by the Australian team, but this time the research was into the risk of postpartum haemorrhage in mothers taking antidepressants in the final three months of their pregnancy.  The results were that for women without psychiatric illness or who were not taking antidepressants the risk of postpartum haemorrhage was 11%. This increased to 16% for women taking antidepressants (558). Risk of severe postpartum haemorrhage and of postpartum anaemia were almost doubled in the SSRI user group.

Dr Patrick O’Brien, a maternal mental health expert and spokesperson for the Royal College of Obstetricians and Gynaecologists (RCOG), said: “While it is useful for women to be aware that SSRI use may increase the risk of postpartum haemorrhage, more research needs to be done to understand what is behind this increased risk. Women should not stop taking their medication without first discussing their options with their doctor and if necessary extra precautions can be taken to prevent postpartum haemorrhage at the time of birth.”

Read the three research abstracts: abstract 1 , abstract 2 and abstract 3 .

Read the RCM summary here 

View RCOG response here