An international team of researchers has found that the use of SSRI antidepressants during pregnancy is associated with an increased risk of gestational diabetes and early adaptation problems in newborns, even after taking maternal depression into account. The study also discovered that taking SSRI medication during pregnancy may reduce the risks of preterm birth and low birth weight.

According to an extensive population-based study, the use of selective serotonin reuptake inhibitor (SSRI) medication during pregnancy was associated with an increased risk of gestational diabetes compared to women with depression who did not use medication. In contrast, the risk of caesarean section, very preterm birth, and low and very low birth weight was lower among those taking SSRIs.

In newborns, SSRI exposure was associated with an increased risk of low 1- and 5-minute Apgar scores, breathing problems, and the need for neonatal care or neonatal intensive care unit treatment. There was no increased risk of major congenital malformations.

When compared with women who had discontinued SSRI use before pregnancy, taking the medication during pregnancy was associated with a lower risk of late preterm birth and low birth weight. However, the risks associated with early adaptation problems in newborns remained elevated.

According to the lead author of the study, Docent Heli Malm, the results show that SSRIs have effects on the early adaptation of newborns that are independent of maternal depression.

“Our results emphasise the significance of individualised treatment decisions during pregnancy. The treatment of depression is important, and the use of SSRIs seems to protect against the risk of preterm birth associated with depression. At the same time, however, it is necessary to closely monitor both the progress of the pregnancy and the health of the newborn,” says Malm.

“The association we have observed with gestational diabetes requires further research in order to better understand the possible cause-and-effect relationship and underlying biological mechanisms,” continues Malm.

Extensive registry-based study with several control groups

The study was conducted in collaboration between the Research Centre for Child Psychiatry at the University of Turku in Finland and Columbia University in New York. It is based on national registry data and covers more than 1.27 million children born in Finland between 1996 and 2018.

Mothers who used SSRIs during pregnancy were compared with women diagnosed with depression who did not use antidepressants during pregnancy, as well as with women who had discontinued taking SSRIs before pregnancy. In addition, the study used sibling comparisons, which allow factors related to heredity and growth environment to be taken into account.

The primary aim of the study was to determine whether the previously reported prenatal risks are attributable to the antidepressant medications themselves or to maternal depression and its severity. The analyses adjusted for several indicators of depression severity.

The Research Centre for Child Psychiatry is part of the Research Council of Finland’s INVEST Research Flagship Centre for Inequalities, Interventions and New Welfare State.