Do SSRI Medications Improve Pregnancy Outcomes?

Detroit, MIWhen it comes to taking SSRI medications during pregnancy, conventional wisdom has tended to be that the benefits of taking the antidepressants outweigh the risks of SSRI side effects, which some studies suggest may include an increased risk of SSRI birth defects. But, a recently published study suggests that the use of selective serotonin reuptake inhibitors while pregnant may not actually improve pregnancy outcomes, calling into question whether they actually are worth the risks.

The study was published online in the journal Human Reproduction (10/31/12) and involved a review of published studies evaluating females who take antidepressant medications and experience infertility. Researchers found that the use of antidepressants during pregnancy is associated with an increased risk of miscarriage, birth defects, preterm birth, persistent pulmonary hypertension of the newborn and newborn behavioral syndrome.

Furthermore, researchers found no evidence that pregnancy outcomes improved when women used antidepressants (in this case, SSRI antidepressants) during their pregnancy. They suggested that there is evidence that psychotherapy, cognitive-behavioral therapy and exercise are beneficial in the general population.

"There is little evidence of benefit from the antidepressants prescribed for the majority of women of childbearing age—and there is ample evidence of risk," researchers wrote. "The best available evidence suggests that antidepressants do not provide clinically meaningful benefit for most women with depression. When used by pregnant women, antidepressants do not improve pregnancy outcomes."

Researchers went on to note that pregnant women who take antidepressants have been shown to have higher rates of miscarriage, preterm birth and infants born with health issues. They even compared the use of SSRIs during pregnancy to the use of DES (diethylstilbestrol) in pregnant women. DES, which was prescribed to prevent miscarriage was later shown to be ineffective and linked to an increased risk of a variety of cancers in the women who were exposed to the drug as fetuses.

According to researchers, "When pregnant women taking SSRI antidepressants are compared with a 'control' group of depressed pregnant women who are not taking such medications, the patients taking the medications only have worsened obstetrical outcomes—never better."

What this means is that women with mild to moderate depression may want to consider alternative therapies, as opposed to taking an antidepressant while pregnant. For women with severe depression, the benefits from taking an antidepressant may outweigh the risks, or the risk of having untreated depression.