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. 2024 Dec;37(1):2313364.
doi: 10.1080/14767058.2024.2313364. Epub 2024 Feb 11.

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period

Yeon Mi Hwang  1   2 , Ryan T Roper  1 , Samantha N Piekos  1 , Daniel A Enquobahrie  3 , Mary F Hebert  4 , Alison G Paquette  5   6 , Priyanka Baloni  7 , Nathan D Price  1   8 , Leroy Hood  1   9 , Jennifer J Hadlock  1
Affiliations

Timing of selective serotonin reuptake inhibitor use and risk for preterm birth and related adverse events: with a consideration of the COVID-19 pandemic period

Yeon Mi Hwang et al. J Matern Fetal Neonatal Med. 2024 Dec.

Abstract

Objective: There is uncertainty around the safety of SSRIs for treating depression during pregnancy. Nevertheless, the use of SSRIs has been gradually increasing, especially during the COVID-19 pandemic period. We aimed to (1) characterize maternal depression rate and use of SSRIs in a recent 10-year period, (2) address confounding by indication, as well as socioeconomic and environmental factors, and (3) evaluate associations of the timing of SSRI exposure in pregnancy with risk for preterm birth (PTB), low birthweight (LBW), and small for gestational age (SGA) infants among women with depression before pregnancy.

Methods: We conducted propensity score-adjusted regression to calculate odds ratios (ORs) of PTB, LBW, and SGA. We accounted for maternal/pregnancy characteristics, comorbidity, depression severity, time of delivery, social vulnerability, and rural residence.

Results: There were 50.3% and 40.3% increases in the prevalence rate of prenatal depression and prenatal SSRI prescription rate during the pandemic. We identified women with depression ≤180 days before pregnancy (n = 8406). Women with no SSRI order during pregnancy (n = 3760) constituted the unexposed group. The late SSRI exposure group consisted of women with an SSRI order after the first trimester (n = 3759). The early-only SSRI exposure group consisted of women with SSRI orders only in the first trimester (n = 887). The late SSRI exposure group had an increased risk of PTB of OR = 1.5 ([1.2,1.8]) and LBW of OR = 1.5 ([1.2,2.0]), relative to the unexposed group. Associations between late SSRI exposure and risk of PTB/LBW were similar among a subsample of patients who delivered during the pandemic.

Conclusions: These findings suggest an association between PTB/LBW and SSRI exposure is dependent on exposure timing during pregnancy. Small for gestational age is not associated with SSRI exposure.

Keywords: COVID-19; Preterm birth; infant, low birth weight; infant, small for gestational age; maternal depression; serotonin uptake inhibitors.

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Conflict of interest statement

YH, RTR, SNP, DAE, MFH, AGP, and PB declare no conflict of interest. JJH has received funding (paid to the Institute for Systems Biology) from Pfizer, Novartis, Janssen, Gilead, Bristol Myers Squibb for research unrelated to this study or any of its findings. LH and NDP are scientific advisors for Sera Prognostics, a pregnancy diagnostics company, and NDP holds stock options. Sera Prognostics is not associated with this study or any of the findings.

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