Antidepressant Use in Pregnancy Linked to Poor Neonatal Outcomes

A new study finds risks of pre-term birth, low birth weight, and postnatal adaptation syndrome were increased by SSRI use during pregnancy.

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Researchers have long debated whether antidepressant use in pregnancy is harmful to the fetus. Many studies have found harmful effects, even finding that babies experience SSRI withdrawal if exposed to the drugs in the womb.

However, some researchers suggest these findings are of poor quality. Because researchers believe it is unethical to conduct a randomized, controlled trial of antidepressant use in pregnancy, studies will always have one major limitation: confounding by indication. This means that whatever researchers find, they can always explain away the results by arguing that those who use antidepressants in pregnancy must have more severe depression compared with those who don’t use antidepressants while pregnant.

In a new study, researchers attempted to control for this limitation by comparing those who used antidepressants but stopped when they became pregnant with those who continued using antidepressants. This ensures that both groups had the same underlying indication to use antidepressants at some point. In total, they analyzed the data from 45,590 births from a Danish medication registry.

The researchers found that the risk for moderate-to-late preterm birth (32-37 weeks) was increased by 1.43 times, the risk for moderately low birth weight (1500–2499 g) by 1.28 times, and the risk for the baby having to be hospitalized by 1.52 times.

Perhaps most troublingly, the risk for postnatal adaptation syndrome (also known as poor neonatal adaptation syndrome) was increased by more than two and a half times (odds ratio 2.59). According to Massachusetts General Hospital/Harvard Medical School, between 25%-30% of babies exposed to SSRIs will experience this syndrome. Another study found that over half (56%) of babies exposed to SSRIs had this problem.

Pregnant woman holding pills and glass of water in handThe researchers explained their results as follows:

“We suggest that the observed associations may be attributable to the severity of the underlying maternal disorders rather than intrauterine effects of the medication.”

Even though they framed their study as better answering this question (“is it the medication or not?”) because it better accounted for this confounding factor, the researchers still explained away their results as being caused by the same confounding factor.

Still, they acknowledge that the risks of antidepressant use should be explained to those who are pregnant or plan to become pregnant so that they can make an informed decision in collaboration with their clinician. The researchers write:

“The potential risks related to antidepressant use during pregnancy should be explained to antidepressant-treated individuals who wish to conceive or who discover their pregnancy to allow an informed decision. Individuals may then weigh up the risks and benefits for themselves in tandem with their treating physician.”

This study is an example of why researchers have lately argued that research in the psy-disciplines is “fundamentally incompatible with hypothesis-driven theoretical science”—because no matter what the result, whether they find an effect or not, researchers in this field always claim that it supports their theory.

Thus, those researchers asked, what is the point of conducting studies like these if researchers are going to claim that their theory is true no matter what result they find?

 

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Rommel, A. S., Momen, N. C., Molenaar, N. M., Agerbo, E., Bergink, V., Munk-Olsen, T., & Liu, X. (2022). Antidepressant use during pregnancy and risk of adverse neonatal outcomes: A comprehensive investigation of previously identified associations. Acta Psychiatrica Scandinavica. DOI: 10.1111/acps.13409 (Link)

9 COMMENTS

  1. I am very against drugging any pregnant woman.

    Quite apart from developmental compromises that may occur to unborn babies there is a possibility they might experience withdrawal syndrome after they are born. Anyone who has had that experience, especially withdrawal from antipsychotics, knows how horrendous those first few MONTHS are. I can imagine how terrifying it would be for a newborn to try to cope with. I beg any obstetrician or paediatrician to inject themselves with raw adrenalin every hour for twenty four hours to get an inkling of how withdrawing neonate small individuals may be suffering.

    Plus a screaming baby for months on end may not lead to the best endearing introduction to motherly love.

    Especially not if the mother is also experiencing turbulent withdrawal agony.

    But it is all good and well looking at the poison in the well whilst not understanding why pregnant mothers are so despairing in the first place. And where are the alternatives to popping a pill whilst popping babies?

    I am not going to blame doctors. Most pregnant women ask and ask and ask for “something” to take the edge off encroaching overwhelming motherhood. Particularly those locked in supposed “relationships” that have a six foot baby already.

  2. I personally believe that taking an antidepressant during pregnancy is risky. But, having said that, this particular study is flawed. The group of women who stopped taking antidepressants when they became pregnant may be very different from the group that continued. So any conclusions are suspect.

    Frankly, I don’t understand why they even conducted a study with such a poor design. But this is not unusual in psychological research or, actually, in a lot of research.

  3. “Because researchers believe it is unethical to conduct a randomized, controlled trial of antidepressant use in pregnancy,….”

    Well, if that is “unethical,” why isn’t it considered “unethical” to hand out the anticholinergic drugs (including the antidepressants and antipsychotics), when all doctors are taught in med school that those drug classes can create “psychosis,” via anticholinergic toxidrome?

    “We suggest that the observed associations may be attributable to the severity of the underlying maternal disorders rather than intrauterine effects of the medication.”

    Blame the patient, anyone? Isn’t that “unethical”?

    “they acknowledge that the risks of antidepressant use should be explained to those who are pregnant or plan to become pregnant so that they can make an informed decision in collaboration with their clinician.”

    So when a doctor, instead, lies to a woman of child-bearing age, and claims an antidepressant is a “safe … med.” Isn’t that also “unethical”?

    “no matter what the result, whether they find an effect or not, researchers in this field always claim that it supports their theory.”

    Isn’t that also “unethical”?

    “what is the point of conducting studies like these if researchers are going to claim that their theory is true no matter what result they find?”

    There is no point in conducting studies like these, and Dr. Thomas Insel said US funding of research into the “invalid” DSM disorders was going to end in 2013. So my question is, when will the US actually stop funding the “bullshit” that is the DSM based psy-disciplines?

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