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Tim F. Oberlander, MD, FRCPC; William Warburton, PhD; Shaila Misri, MD, FRCPC; Jaafar Aghajanian, BSc; Clyde Hertzman, MSc, MD, FRCPC

Arch Gen Psychiatry. 2006;63:898-906.

Context  Prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants and maternal depression both alter neonatal health, and distinguishing the effects of each influence remains challenging.

Objective  To determine whether exposure to SSRIs and depression differs from exposure to maternal depression alone.

Design  Using population health data, records of neonatal birth outcomes were linked to records of maternal health and prenatal maternal prescriptions for SSRIs.

Setting  Population of British Columbia, Canada.

Participants  Mothers and their infants, representing all live births during a 39-month period (N = 119 547) (1998-2001).

Main Outcome Measures  Outcomes from infants of depressed mothers treated with SSRIs (SE-D) were compared with outcomes from infants of depressed mothers not treated with medication (DE) and nonexposed controls. To control for maternal mental illness severity, propensity score matching was used to identify a comparison group of DE mothers who were similar to the SE-D mothers in characteristics in the year preceding and during pregnancy.

Results  Fourteen percent of mothers were diagnosed as having depression during their pregnancy, and the incidence of prenatal SSRI exposure increased from 2.3% to 5.0% during a 39-month period. Birth weight and gestational age for SE-D infants were significantly less than for DE infants, as was the proportion of infants born at less than 37 weeks (95% confidence interval [CI], –1 to –64, –0.25 to –0.45, and –0.009 to –0.04, respectively), although differences in the incidence of birth weight less than the 10th percentile for gestational age were not significant. An increased proportion of SE-D infants had neonatal respiratory distress (13.9% vs 7.8%), jaundice (9.4% vs 7.5%), and feeding problems (3.9% vs 2.4%) compared with DE infants (95% CI of difference, 0.042-0.079, 0.003-0.334, and 0.005-0.025, respectively). When outcomes were compared between SE-D and propensity score–matched DE neonates, SE-D was associated with increased incidence of birth weight below the 10th percentile and rates of respiratory distress.

Conclusion  With linked population health data and propensity score matching, prenatal SE-D exposure was associated with an increased risk of low birth weight and respiratory distress, even when maternal illness severity was accounted for.

Author Affiliations: Departments of Pediatrics (Dr Oberlander) and Psychiatry (Dr Misri) and Human Early Learning Partnership, Faculty of Graduate Studies (Drs Oberlander, Warburton, and Hertzman and Mr Aghajanian), University of British Columbia, Vancouver.

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