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December 2, 2002

Study links popular antidepressants to premature birth

Group Health finds risk of early delivery increases from 5 to 10 percent

Seattle—Pregnant women who take the popular antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have an increased risk of premature delivery according to a study conducted at Group Health Center for Health Studies.

Published in the December 2002 issue of The American Journal of Psychiatry, the study found no link between SSRI use during pregnancy and either birth defects or developmental delay.

"Our findings offer both reassurance and concern," says Greg Simon, MD, MPH, associate investigator at the Center and the study’s principal investigator. The reassurance is there appears to be no increased risk of malformations, Simon explained. The concern is that SSRIs appear to increase the risk that a baby will be born, on average, a week earlier than those not exposed to these drugs. The chances of birth before 36 weeks—a standard definition of premature—increases from 5 percent to 10 percent.

While this risk of premature delivery is low, the findings affect a large population of women. SSRIs represent more than half the antidepressants sold in the United States and their use is increasing. SSRIs include fluoxetine (brand name Prozac), paroxetine (Paxil), and sertraline (Zoloft).

"Each woman has to consider her own situation and decide what to do," says Simon, who is also a Group Health psychiatrist. "A woman who has severe depression while not using this drug would probably continue to take it. But a woman who has relatively mild depression, might choose to stop using it during pregnancy."

To conduct the study, Simon and his colleagues compared medical and pharmacy records from two groups of mothers and their babies. The mothers in both groups were being treated for depression during pregnancy, but only one group of mothers had received antidepressants. The researchers found that SSRI exposure anytime during pregnancy was associated with earlier delivery and consequent lower birth weight. Exposure to SSRIs in the third trimester was also associated with a decreased Apgar score, which is a measure of a newborn’s well being at the time of birth.

The study was funded by a grant from the National Institute of Mental Health. Pediatricians Michael Cunningham, MD, PhD, of Children’s Hospital and Regional Medical Center in Seattle, and Robert L. Davis, MD, an associate investigator at CHS, were co-investigators for the study.

About Group Health Center for Health Studies
Group Health Center for Health Studies conducts epidemiologic, health-services, and clinical research related to prevention, diagnosis, and treatment of major health problems. Funded primarily through government and private research grants, the Center is located in Seattle, Washington.

Group Health Cooperative is the nation’s largest consumer governed health care system, serving nearly 600,000 people in Washington and Idaho.

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