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No impact of antidepressants taken during pregnancy on child’s development

But SSRIs may be linked to heightened risk of haemorrhage after the birth, evidence suggests

Caroline White

Wednesday, 16 September 2015

Taking antidepressants during pregnancy does not seem to adversely affect the child’s neurodevelopment or behaviour in the long term, suggest the findings from three studies published today in BJOG: An International Journal of Obstetrics and Gynaecology.

But these drugs may be associated with a heightened risk of heavy bleeding after the birth, the findings suggest.

Depression and anxiety are extremely common during pregnancy, with around 12% of women in the UK experiencing depression at some point during pregnancy and the postnatal period.

The use of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) to treat depression during pregnancy has become increasingly widespread, but it is unclear whether these drugs are associated with any increased risk of developmental harm to the foetus or health problems for the mother.

In one study,* researchers from the Norwegian Institute of Public Health looked at the effects of prenatal exposure to SSRIs on motor skill development at 3 years old in 51,404 children from the Norwegian Mother and Child Cohort Study.

In this cohort, 159 mothers reported prolonged use of SSRIs during pregnancy. Their children had a slight delay in the development of fine and gross motor skills compared to children whose mothers had not taken these drugs while pregnant. But the numbers are so small, no change in clinical practice is warranted, conclude the researchers.

Marte Handal, lead study author, commented: “Only a very small number of children had a severe delay. Even though we did take into account maternal symptoms of depression we still did not have complete information on the severity of the maternal depression in the different groups. 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.”

In another study,** an Australian team analysed data from 49,000 women registered on the Danish National Birth Cohort, to look at the impact of prenatal exposure to SSRIs on behavioural problems at aged 7.

The results showed that untreated prenatal depression (231 children) was associated with an increased risk of problem behaviour in the children, hyperactivity, inattention, and peer problems. This increased risk was not seen in the children (210 children) whose mothers took antidepressants, including SSRIs.

In a separate study,*** the same team examined the risk of postpartum haemorrhage (the loss of between 500 to 1,000ml of blood within the first 24 hours after giving birth) in mothers taking antidepressants in the final three months of their pregnancy, at the Women's and Children's Hospital in Adelaide, Australia.

For women who were not mentally ill (28,000 women) or who were not taking antidepressants (1,292), the risk of was 11%. This increased to 16% for women taking antidepressants (558). Risk of severe postpartum haemorrhage and of postpartum anaemia almost doubled in those taking SSRIs.

Dr Luke Grzeskowiak, lead author of the Australian studies, said: “It is reassuring to find that prenatal exposure to antidepressants did not affect a child’s behaviour at age 7, however as with any medication, the benefits and risks must always be considered.”

He added: "Regarding our other study, overall, the risks for postpartum haemorrhage are largely unknown. We found separate increases in risk with placenta praevia, prolonged labour, hypertension and assisted vaginal delivery, as well as the increased risk seen with antidepressant use. However we did not have data on known risks such as use of oxytocin during delivery, nor did we have any data on the severity of the underlying maternal psychiatric illness.

“Consequently, it is possible that the women who took antidepressants late in pregnancy were those with the most severe illness and it is this which is responsible for the increased risk of postpartum haemorrhage and not the antidepressant. Based on this study alone, we do not recommend that women stop taking medication for depression during pregnancy, but are closely monitored in order to reduce the risk of any potential increased risk of bleeding as much as possible.”

Dr Patrick O’Brien, a maternal mental health expert and spokesperson for the Royal College of Obstetricians and Gynaecologists said that it was important to consider treatment on a case by case basis because untreated maternal depression can itself be harmful.

But he added: “Pregnant women and mothers can be reassured from these studies which suggest there are no clinically important long-term neurodevelopmental or behavioural problems associated with taking SSRIs.”

And he 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 the birth.”

* M Handal, et al. Motor development in children prenatally exposed to selective serotonin reuptake inhibitors: a large population-based pregnancy cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, September 2015. DOI: 10.1111/1471-0528.13582

** LE Grzeskowiak, et al. Prenatal antidepressant exposure and child behavioural outcomes at 7 years of age: a study within the Danish National Birth Cohort. BJOG: An International Journal of Obstetrics & Gynaecology, September 2015. DOI: 10.1111/1471-0528.13611

*** LE Grzeskowiak, et al. Antidepressant use in late gestation and risk of postpartum haemorrhage: a retrospective cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, September 2015. DOI: 10.1111/1471-0528.13612

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