Mood-boosting pills can aid depression, but when given to pregnant women they can lead to delayed head growth and preterm birth, researchers have warned.
"The importance of treating maternal depression during pregnancy is well known," say Dr Hanan El Marroun of Erasmus Medical Centre, Rotterdam, the Netherlands, and colleagues in the Archives of General Psychiatry.
Selective serotonin reuptake inhibitors, such as Prozac, are frequently prescribed to pregnant women, but knowledge about their potential unintended effects on health of the unborn child is lacking.
The team examined the effects of SSRI use on foetal growth and birth outcomes in 7,696 pregnant women, of whom 99 used SSRIs.
Untreated depression was linked with reduced foetal body and head growth. Mothers treated with SSRIs had reduced depressive symptoms and no increased risk of reduced foetal body growth. However, SSRI use was associated with reduced foetal head growth and double the chance of preterm birth.
This may be due to previous depression affecting maternal physiology and affecting foetal development, the authors suggest. Or SSRIs may directly affect foetal brain growth through serotonin levels. A further possible explanation is that risk factors such as smoking, drinking and low socioeconomic status may be linked to SSRI use.
The authors point out that small head size in infants may predict behavioural problems and psychiatric disorders in later life. But they add: "We must be careful not to infer an association of SSRI use in pregnancy with future developmental problems.
"Our findings are of important value because there is a paucity of data regarding safety of SSRI use during pregnancy and possible consequences on foetal health. More long-term drug safety studies are needed before evidence-based recommendations can be derived," they conclude.
Maternal Use of Selective Serotonin Reuptake Inhibitors, Fetal Growth, and Risk of Adverse Birth Outcomes. El Marroun, H. et al. Archives of General Psychiatry March 5 2012 doi:10.1001/archgenpsychiatry.2011.2333
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