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SSRI use in pregnancy may affect fetal brain development

Study suggests prenatal use of selective serotonin inhibitors may impact on fetal brain development

Ingrid Torjesen

Tuesday, 10 April 2018

Use of selective serotonin inhibitors (SSRIs) by women who are pregnant may influence brain development in the fetus, particularly in regions critical to emotional processing, a study* published in JAMA Paediatrics suggests.

Between 2011 and 2016, researchers at Columbia University Irving Medical Center in New York, US, used magnetic resonance imaging (MRI) to scan the brains of infants. They examined brain scans of 98 infants - 16 babies whose mothers took SSRIs for depression during pregnancy, 21 babies whose mothers had untreated depression during pregnancy, and 61 babies born to women without depression.

They found that infants whose mothers took SSRIs during pregnancy had greater brain volume in regions of the brain that are critical for emotional processing, compared to babies whose mothers had untreated depression or were not experiencing depression. Infants whose mother had taken SSRIs had increased volumes of the right amygdala and right insular cortex and increased white matter connection strength between the two regions.

Untreated prenatal depression poses risks to both the infant and mother, so the decision to initiate, continue, or suspend SSRI treatment remains a clinical dilemma, the researchers said, “Further study is required to better elucidate the effects of gestational SSRI exposure on fetal brain development and later life susceptibility to depressive, cognitive, and motor abnormalities. Such information may eventually allow more informed clinical decisions about how to best treat psychiatric disorders during pregnancy for the benefit of both mother and fetus.”

Commenting on the findings, Professor Andrew Whitelaw, Emeritus Professor of Neonatal Medicine, University of Bristol, said that the right amygdala and right insula regions of the brain “are involved in the regulation of fear and anxiety and other studies have shown that enlargement and activity in these regions are associated with anxiety disorders.”

“However, infants in this study were examined at just a few weeks of age and the findings may be transient. We do not know how predictive the imaging findings in newborns are of later depression or anxiety in childhood or adolescence,” he said.

“Wisely, the authors do not conclude that SSRI treatment should be avoided in pregnancy. Untreated depression in pregnancy has serious risks for mother and baby and psychiatrists have the difficult task of identifying the pregnant women where SSRI treatment is the least risky decision.”

*Lugo-Candelas C, Cha J, Hong S, et al. Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy. JAMA Pediatrics, Published online April 9, 2018. doi:10.1001/jamapediatrics.2017.5227

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