SSRIs and adverse pregnancy outcomes

Abstract

Wen et al1Wen S. Yang Q. Garner P. et al.Selective serotonin reuptake inhibitors and adverse pregnancy outcomes.Am J Obstet Gynecol. 2006; 194: 961-966Abstract Full Text Full Text PDF PubMed Scopus (187) Google Scholar may have overlooked a small but crucial methodologic problem when they reported on the association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse pregnancy outcomes. Because of this methodologic shortcoming and as a result of their article, the consequences in daily clinical practice may be counterproductive. Based on their design, we argue that not so much exposure to SSRIs but exposure to depression during pregnancy is a more plausible risk factor for adverse pregnancy outcomes. The authors compare a group of mothers who used SSRIs during pregnancy and a matched control cohort of women who did not and who were matched for demographic data. This probably means that, as opposed to those in the control group, fetuses in the SSRI group were exposed to depression of the mother and more specifically to persistent perinatal maternal stress. Exposure to persistent perinatal stress and depression during pregnancy is associated with congenital anomalies, low birthweight, preterm birth, preeclampsia, operative delivery procedures, and developmental emotional and behavioral problems in children.2Henry A.L. Beach A.J. Stowe Z.N. et al.The fetus and maternal depression: implications for antenatal treatment guidelines.Clin Obstet and Gynecol. 2004; 47: 535-546Crossref PubMed Scopus (25) Google Scholar, 3Halbreich U. The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions: the need for interdisciplinary integration.Am J Obstet Gynecol. 2005; 193: 1312-1322Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar Therefore, to be able to link SSRI use to adverse pregnancy outcomes, a proper control group of mothers with depression during pregnancy without SSRI use can answer only this question. The article, by prematurely suggesting a link between SSRI use and adverse pregnancy outcome, will make severely depressed pregnant women more reluctant to accept adequate treatment that, if effective, would result in less exposure of the fetus to persistent perinatal stress of the mother and facilitate the mother and child to a better quality of bonding after delivery. Selective serotonin reuptake inhibitors and adverse pregnancy outcomesAmerican Journal of Obstetrics & GynecologyVol. 194Issue 4PreviewThe purpose of this study was to assess the safety of the use of selective serotonin reuptake inhibitors in pregnancy. Full-Text PDF ReplyAmerican Journal of Obstetrics & GynecologyVol. 196Issue 1PreviewIn their letter, Dr Heres et al argued that we may have overlooked a methodologic problem when we reported on the association between use of selective serotonin reuptake inhibitors (SSRIs) and adverse pregnancy outcomes. They suggested that, in the assessment of the effects of SSRIs use during pregnancy, the more appropriate control group should be mothers with a depression during pregnancy without SSRI use, not the cohort of women from the remainder of the database who were matched for demographic data. Full-Text PDF