SSRI Use During Late Pregnancy Only Linked to Minor Risks for Newborns

For many pregnant people with depression and anxiety, the decision to use selective serotonin reuptake inhibitors (SSRIs) is difficult. While the risks associated with mental health disorders are well described, the ones associated with SSRI treatment have not been clearly defined. 

New research from the Department of Pediatrics at UC San Francisco details the risks of SSRI exposure for the newborn that should be weighed alongside the potential benefits for the mother and baby. The results, published in Archives of Disease in Childhood: Fetal and Neonatal Edition, shows that SSRI use during late pregnancy (i.e., after 20 weeks) more than doubles the risk of delayed neonatal adaptation. 

Transitioning from a fetus to a newborn is a complex process, and at birth, the baby adapts to their new environment by clearing fetal fluid from their lungs and establishing consistent breathing. Neonates with delayed adaptation may require intervention to support this transition, especially respiratory support.

Lead author of the study, Marie-Coralie Cornet, MD, Assistant Professor of Pediatrics in the Division of Neonatology, says “frequency of SSRI treatment during pregnancy has increased by one-third in the last decade in the United States. Our work quantifies the immediate risks for the newborn to help clinicians and pregnant patients make an informed decision and to help pediatricians prepare adequately for these births.”

Detailing the Risks

Using a data set with over 280,000 infants born in Northern California, 2.7% (7,575) infants in the study were exposed to SSRIs after 20 weeks of pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed infants compared to 4.4% of those not exposed.

Importantly, the study adjusted for the presence and severity of maternal depression and anxiety during pregnancy, isolating the impact of SSRI treatment. After adjustment, while SSRI exposure remained associated with delayed neonatal adaptation, the study found no association with more severe outcomes such as pulmonary hypertension, seizures, or brain injury, as reported in some previous studies. 

“Our large and detailed data set shows that there will be one additional case of delayed neonatal adaptation for every 22 pregnant people treated with SSRIs and one additional NICU admission for every 40 treated. Reassuringly, more severe adverse outcomes are very unlikely to increase due to SSRI exposure,” says Cornet.

Weighing SSRI Benefits

Cornet recommends pregnant people and their physicians discuss the known but minor additional risks associated with SSRI use and the potential benefits of depression treatment for both mother and infant to decide on the best treatment option during their pregnancy.

“The risks our study outlines may be acceptable for some parents as SSRIs are considered an effective treatment for maternal depression and anxiety. We also showed that the risks are even lower with low-dose sertraline,” says Cornet.

After investigating the impact of SSRIs on short-term neonatal outcomes, Cornet and her team plan to build on their findings to confirm that SSRI treatments are not linked to longer-term side effects either.

Additional co-authors from UCSF include Yvonne Wu, MD, MPH, Professor of Neurology and Pediatrics, Aaron Scheffler, PhD, MS, Assistant Professor of Epidemiology and Biostatistics, Thomas Newman, MD, MPH, Professor of Epidemiology and Biostatistics and Pediatrics, and Michael Kuzniewicz, MD, MPH, Assistant Professor of Pediatrics.