A review of the safety of selective serotonin reuptake inhibitors during pregnancy

Antidepressant treatment may be desirable or necessary during pregnancy; however, the benefit of treatment must balance the benefits to the mother with any risk to the developing fetus. In order to make educated, patient-specific, benefit-to-risk assessments, an understanding of possible risks associated with in-utero antidepressant exposure is important. We reviewed all published cohort-controlled studies (n = 4) and prospective surveys (n = 5) regarding SSRI use in pregnancy. Outcomes from over 1000 fluoxetine-exposed pregnancies, more than for any other antidepressant, indicate that first trimester fluoxetine exposure does not statistically significantly increase risk for spontaneous abortion or major malformation. Outcomes from nearly 300 pregnancies exposed to another SSRI (sertraline, paroxetine, or fluvoxamine) suggest the same conclusion. Following in-utero SSRI exposure, birthweight, rates of prematurity, and postnatal complications appear similar to control values. Preschool age children exposed to fluoxetine in-utero show no significant differences from controls in global IQ, language, or behavior; such long-term data are not available for other SSRIs. The substantial clinical experience with fluoxetine-exposed pregnancies and the preliminary data regarding other SSRIs is reassuring when considering depression treatment for women of childbearing potential. Copyright (C) 1999 John Wiley & Sons, Ltd.