A 2006 study reported more fetal deaths among pregnancies with a recorded prescription for an SSRI antidepressant than among matched pregnancies without one. The result deserved investigation, but the older version of this article treated it as proof that the medicine caused stillbirth. Later, much larger studies have not found a clear increase in stillbirth risk after accounting for maternal health and other differences. No one should start or stop a medicine during pregnancy based on one news story.
The original Canadian study
Researchers used records from Saskatchewan for 972 pregnancies with at least one SSRI prescription in the year before delivery and 3,878 matched pregnancies without a recorded SSRI prescription. The exposed group had higher recorded rates of preterm birth, low birth weight, fetal death, and infant seizures. Fetal death occurred in about 1.1% of the exposed group and 0.4% of the comparison group; the estimate was imprecise because these events were uncommon. The original study is Selective serotonin reuptake inhibitors and adverse pregnancy outcomes.
A prescription record does not prove when or how regularly a person took the drug. The groups may also differ in severity of depression, smoking, other illnesses, and access to care. This was an observational study, so it cannot isolate the medicine's effect from all those factors.
What larger follow-up research found
A Nordic cohort examined more than 1.6 million singleton births. Crude stillbirth rates were somewhat higher among women with SSRI exposure, but after adjustment for maternal characteristics and psychiatric history the researchers found no statistically significant association with stillbirth or infant mortality (Nordic SSRI pregnancy and stillbirth cohort). A Danish population study likewise investigated timing of SSRI exposure and stillbirth (Danish SSRI pregnancy and mortality study). These studies still cannot prove zero risk, but they make the old headline's simple causal claim untenable.
Support during pregnancy
Depression and anxiety during pregnancy also deserve care. A small randomized trial of 42 pregnant women found that pregnancy-adapted internet cognitive behavioral therapy, added to usual care, reduced depressive symptoms compared with usual care alone (Internet cognitive behavioral therapy trial for antenatal depression). This is a non-drug option worth discussing, though one small trial does not settle how it compares for every person or degree of illness.
Someone who is pregnant or planning pregnancy can review treatment choices with their maternity and mental-health clinicians, including psychotherapy, medication benefits and risks, and support at home. Abruptly stopping an antidepressant can cause withdrawal symptoms or a return of depression. The evidence supports an individualized decision, not a blanket warning that an SSRI causes stillbirth.
