SSRIs Linked to Low Apgar Scores

Dallas, TXAnother study examining the risk of SSRI side effects in infants suggests that the use of selective serotonin reuptake inhibitors while pregnant could result in babies with low Apgar scores. The study adds to literature on SSRIs, which has provided conflicting results as to what risk of SSRI birth defects infants face when exposed to the antidepressants prior to birth.

The study was conducted in Denmark and published in The British Journal of Psychiatry (published online 2/21/13). Previous research found low Apgar scores in infants exposed to SSRI medications, but those studies did not determine if it was the antidepressants or the mother’s underlying depression that resulted in the low Apgar scores.

Apgar tests are administered to infants at one and five minutes after birth, to determine the infant’s ability to breathe and whether or not the newborn is having heart trouble. The test uses breathing effort, muscle tone, reflexes, heart rate and skin color as factors in determining the infant’s health. Scores of seven or higher - up to a maximum of 10 - are considered normal, while scores lower than seven are considered low.

Researchers in Denmark examined data from the Medical Birth Register, the Psychiatric Central Register and the National Prescription database. They found that infants exposed to SSRIs had an increased risk of low Apgar scores, but that risk did not extend to infants exposed to other antidepressants. Furthermore, maternal depression without the use of antidepressants was not associated with low Apgar scores, and antidepressant use prior to - but not during - pregnancy was also not associated with a low Apgar score.

“Use of SSRIs during pregnancy increases the risk of a low Apgar score independently of maternal depression,” researchers concluded. In other words, the study suggests that the mother’s depression may not be linked to low Apgar scores.

SSRIs have previously been linked to persistent pulmonary hypertension of the newborn, although results have been conflicting. The US Food and Drug Administration (FDA) recently revised its stance on SSRI medications. On December 14, 2011, the FDA said that it is premature to reach a conclusion about the link between the use of SSRIs while pregnant and a risk of PPHN in infants. In making its announcement, the FDA cited conflicting research results, including two studies that suggested an increased risk of PPHN with SSRI use and three studies that did not support that finding.