Selective serotonin reuptake inhibitor use during pregnancy and maternal depression—a nationwide birth cohort study on risks to the mother and the newborn

BACKGROUND: Maternal underlying depression may confound previously reported associations between selective serotonin reuptake inhibitor (SSRI) use and adverse pregnancy and neonatal outcomes. OBJECTIVE: To determine whether SSRI use during pregnancy is associated with an increased risk of pregnancy and neonatal complications after adjusting for indicators of maternal depression severity. STUDY DESIGN: This population-based birth cohort study used data from national registers in Finland and included 1272,587 singleton live births from 1996 to 2018. Pregnancy outcome of women with two or more SSRI purchases during pregnancy (N=19,020) were compared to women with a diagnosis of depression but no antidepressant use (N=19,625), and women who discontinued SSRIs before pregnancy (n=3145). Analyses included adjustment for several indicators of depression severity and within-family sibling comparisons. RESULTS: After adjusting for confounders and comparing to women with depression who did not use antidepressants, maternal SSRI use was associated with an increased risk of gestational diabetes (OR 1.14; 95% CI 1.07-1.22), while the risk of cesarean section (CS), late (32-36+6 weeks' gestation) and very preterm birth (