Use of Selective Serotonin Reuptake Inhibitors During Pregnancy and the Risk of Preterm Birth

Friday, August 26, 2022

1:30 PM – 1:45 PM CEST

Location: Congress Hall D5

Publication Number: 43

Background: Selective serotonin reuptake inhibitors (SSRIs) are the most common antidepressants used during pregnancy. Observational studies have shown that both exposure to SSRIs during pregnancy and antenatal maternal depression are associated with preterm birth (PTB), making it difficult to disentangle the effects of the condition and the treatment.

Objectives: We aimed to estimate the effects of SSRIs and maternal depression on the risk of PTB, using data from electronic health records (EHR) across two independent health systems.

Methods: We used primary care EHR from IMRD-UK (incorporating data from THIN, a Cegedim database) and validation EHR from UCSF in the US. The cohorts included 216,070 deliveries of 176,866 patients from 1996-2018 at IMRD-UK, and 10,284 deliveries from 2013-2016 at UCSF. We applied large-scale propensity score stratification that included all demographic and clinical covariates (conditions, drug prescriptions, observations, and procedures). We estimated the odds ratio (OR) of PTB ( <37 weeks gestational age) between groups using logistic regression. We compared patients exposed to SSRIs vs. unexposed to any antidepressant during pregnancy in the entire cohort, and in subgroups of patients with a history of depression and patients with recent SSRI prescriptions before pregnancy. We also compared unexposed patients with/without a known history of depression.

Results: There were 17,615 (8.2%) PTBs in the IMRD-UK cohort, and 1,550 (12.9%) in the UCSF cohort. IMRD-UK patients exposed to SSRIs during pregnancy (N=9,960) had higher risk of preterm delivery, compared to unexposed (OR 1.12 [1.04,1.19], P< 0.01). In the subgroups of patients with a history of depression (N=44,501) and with prior SSRI prescriptions (N=18,801), there were no differences in risk of PTB between exposed and unexposed patients (OR 1.03 [0.95,1.12], P=0.51 and 1.02 [0.92,1.12], P=0.72, respectively). In the unexposed subgroup, patients with a history of depression were also at higher risk of PTB, compared to those without known depression (OR 1.09 [1.05,1.13], P< 0.01). The validation analysis of these findings using UCSF data is on-going.

Conclusions: While we observe that patients exposed to SSRIs during pregnancy had a higher risk of PTB, sensitivity analyses suggest that depression, rather than SSRI exposure per se, may be related to a higher risk of PTB. For patients with a known history of depression or that have used SSRIs before pregnancy, exposure during pregnancy does not seem to increase the risk of preterm birth.

Presenting Author(s)

Guy Amit

KI Research Institute
Kfar Malal, Israel

Slides

Co-Author(s)

AT

Alice Tang

University of California, San Francisco, United States
Chen Yanover, PhD

Senior Researcher
KI Research Institiute
Kfar Malal, Israel
MB

Maytal Bivas-Benita

KI Research Institute, Israel
PA

Pinchas Akiva

KI Research Institute, Israel
IG

Irena Girshovitz

KI Research Institute, Israel
BL

Brian Le

University of California, San Francisco, United States
TO

Tomiko T. Oskotsky

University of California, San Francisco, United States
JR

Jacquelyn Roger

University of California, San Francisco, United States
SW

Sarah Woldemariam

University of California, San Francisco, United States
MR

Melissa Rosenstein

University of California, San Francisco, United States
CB

Cinthia Blat

University of California, San Francisco, United States
TH

Tal Helbitz

KI Research Institute, United Kingdom
VB

Vered Bar

Sheba Medical Center, Israel
MS

Marina Sirota

University of California, San Francisco, United States