Maternal use of selective serotonin reuptake inhibitors, fetal growth, and risk of adverse birth outcomes

Abstract

Context: Selective serotonin reuptake inhibitors (SSRIs) are frequently prescribed to pregnant women, but knowledge about their unintended effects on child health is scarce. Objective: To examine the effects of maternal SSRI use during pregnancy on fetal growth and birth outcomes. Design: The study was embedded in the Generation R Study, a prospective population-based study from fetal life onward. Participants: Seven thousand six hundred ninety-six pregnant women were included. Selective serotonin reuptake inhibitor use was assessed by questionnaires in each trimester and verified by pharmacy records. Using depressive symptom scores from the Brief Symptom Inventory, 7027 pregnant mothers (91.3%) had no or low depressive symptoms, 570 pregnant mothers (7.4%) had clinically relevant depressive symptoms and used no SSRIs, and 99 pregnant mothers (1.3%) used SSRIs. Main Outcome Measures: Fetal ultrasonography was performed in each trimester. We determined fetal body and head growth with repeated assessments of body and head size. The birth outcomes studied were preterm birth, small for gestational age, and low birth weight. Results: Fetuses from mothers with prenatal depressive symptoms showed reduced body growth (β=-4.4 g/wk; 95% CI: -6.3 to -2.4; P