Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Disclosures: Wiggs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 17, 2022
2 min read
Save

Antidepressant use during pregnancy does not increase risk for neonatal seizures, epilepsy

Disclosures: Wiggs reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Using serotonergic antidepressants during the first trimester of pregnancy did not increase the risk for neonatal seizures or epilepsy, according to data published in Neurology.

While studies have shown that exposure to selective-serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) during the third trimester can negatively affect newborns, less is known about the impact of SSRIs and SNRIs taken during the first trimester, the researchers said.

Data derived from Wiggs KK, et al. Neurology. 2022;doi:10.1212/WNL.0000000000200516.
Data derived from Wiggs KK, et al. Neurology. 2022;doi:10.1212/WNL.0000000000200516.

“Pregnant women who experience depression are often faced with a dilemma: Do I live with the depressive symptoms I am experiencing, or do I take a medication that helps alleviate my symptoms but has an uncertain influence on my baby’s health and development?” Kelsey Kathleen Wiggs, BS, BA, a PhD student at Indiana University in Bloomington, Indiana, told Healio. “This decision is made more difficult by the fact that untreated depression during pregnancy may have negative effects also for the child.”

Defining a cohort

Wiggs and colleagues analyzed data from a series of Swedish registers that contained information on maternal age, medication use and reproductive history; psychiatric and epilepsy diagnoses in parents and children; and socioeconomic indices.

Within these registers, they evaluated all children (n = 1,551,906) born from Jan. 1, 1996, to Nov. 30, 2013, for a diagnosis of neonatal seizures within the first month of life. They also evaluated a subset of the neonatal seizure group for epilepsy diagnoses within 2 years of birth. To allow for adequate time for follow-up, the researchers included 1,367,087 children born between Jan. 1, 1996, and Dec. 31, 2011, in their epilepsy analyses.

Overall, 21,104 (1.36%) of the 1,551,906 children included for analyses were exposed to SSRIs, with the most common being sertraline (0.49%), citalopram (0.48%) and fluoxetine (0.2%). SNRI exposure occurred in 2,211 (0.14%) children, with venlafaxine being the most common (0.12%).

Risk for neonatal seizures, epilepsy

Before adjustment, children with SSRI or SNRI exposure were more likely to experience seizures in the first month of life compared with children with no exposure (RR = 1.41; 95% CI, 1.03-1.94). Also, children with antidepressant exposure had a 21% greater risk for epilepsy within the first 2 years of life compared with children who had no exposure (95% CI, 1.03-1.43).

However, adjustments for maternal indications for antidepressant use accounted for some of the increased risk for neonatal seizures (adjusted RR = 1.3; 95% CI, 0.94-1.79) and epilepsy (adjusted HR = 1.13; 95% CI, 0.95-1.33). Additional adjustment showed that parental epilepsy history had little or no effect on the risk for neonatal seizures or epilepsy.

Full adjustment for parental and pregnancy-related factors accounted for much of the remaining risk for seizures (aRR = 1.1; 95% CI, 0.79-1.53) and epilepsy (aHR = 0.96; 95% CI, 0.81-1.14).

Kelsey Kathleen Wiggs, BS, BA
Kelsey Kathleen Wiggs

“The implications of this are that there need not be any greater concern that use of SSRIs/SNRIs in pregnancy will cause neonatal seizures and epilepsy,” Wiggs told Healio. “This should be reassuring to both doctors and patients weighing the risks and benefits of antidepressant medication in pregnancy.”

Moving forward, Wiggs suggested researchers examine the impact of high antidepressant dosage amounts on neonatal seizure and epilepsy risk, as well as determine “the full scope of the safety of these and other medications in pregnancy, aside from seizure outcomes in children.”