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Selective Serotonin Reuptake Inhibitors During Pregnancy and Risk of Stillbirth and Infant Mortality
JAMA. 2013;309(1):48-54.
Olof Stephansson, MD, PhD; Helle Kieler, MD, PhD; Bengt Haglund, PhD; Miia Artama, PhD; Anders Engeland,
PhD; Kari Furu, PhD; Mika Gissler, PhD; Mette Nørgaard, MD, PhD; Rikke Beck Nielsen, MSc; Helga Zoega, PhD;
Unnur Valdimarsdóttir, PhD

Inhibiteurs sélectifs du recaptage de la sérotonine
peuvent être utilisés pendant la grossesse

Parmi les femmes ayant eu des naissances uniques dans les pays nordiques, aucune association significative n'a été trouvée entre l'utilisation des ISRS pendant la grossesse et le risque de mortinatalité, de mortalité néonatale, post-néonatale et la mortalité. Selon les auteurs, cette recherche montre que le taux de bébés mort-nés ou de décès du nourrisson est certes très légèrement plus élevé chez les femmes consommant des antidépresseurs mais les médicaments ne sont pas en cause. Les responsables seraient les maladies psychiatriques graves, le tabagisme et l'âge plus avancé de ces futures mamans sous antidépresseurs. Toutefois, les décisions relatives à l'utilisation des ISRS pendant la grossesse doit tenir compte des autres résultats périnataux et les risques associés à la maladie mentale de la mère.

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Revoir également Grossesse et dépression

Importance Maternal psychiatric disease is associated with adverse pregnancy outcomes. Use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy has been associated with congenital anomalies, neonatal withdrawal syndrome, and persistent pulmonary hypertension of the newborn. However, the risk of stillbirth and infant mortality when accounting for previous maternal psychiatric disease remains unknown.

Objective To study risk of stillbirth and infant mortality associated with use of SSRIs during pregnancy.

Design, Setting, and Participants Population-based cohort study from all Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) at different periods from 1996 through 2007. The study included women with singleton births. We obtained information on maternal use of SSRIs from prescription registries. Maternal characteristics, pregnancy, and neonatal outcomes were obtained from patient and medical birth registries.

Main Outcome Measures We used logistic regression to estimate relative risks of stillbirth, neonatal death, and postneonatal death associated with SSRI use during pregnancy taking into account maternal characteristics and previous psychiatric hospitalization.

Results Among 1 633 877 singleton births in the study, 6054 were stillbirths; 3609, neonatal deaths; and 1578, postneonatal deaths. A total of 29 228 (1.79%) of mothers had filled a prescription for an SSRI during pregnancy. Women exposed to an SSRI presented with higher rates of stillbirth (4.62 vs 3.69 per 1000, P = .01) and postneonatal death (1.38 vs 0.96 per 1000, P = .03) than those who did not. The rate of neonatal death was similar between groups (2.54 vs 2.21 per 1000, P = .24). Yet in multivariable models, SSRI use was not associated with stillbirth (adjusted odds ratio [OR], 1.17; 95% CI, 0.96-1.41; P = .12), neonatal death (adjusted OR, 1.23; 95% CI, 0.96-1.57; P = .11), or postneonatal death (adjusted OR, 1.34; 95% CI, 0.97-1.86; P = .08). Estimates were further attenuated when stratified by previous hospitalization for psychiatric disease. The adjusted OR for stillbirth in women with a previous hospitalization for psychiatric disease was 0.92 (95% CI, 0.66-1.28; P = .62) and was 1.07 (95% CI, 0.84-1.36; P = .59) for those who had not been previously hospitalized. The corresponding ORs for neonatal death were 0.89 (95% CI, 0.58-1.39; P = .62) for women who were hospitalized and 1.14 (95% CI, 0.84-1.56; P = .39) for women who were not. For postneonatal death, the ORs were 1.02 (95% CI, 0.61-1.69; P = .95) for women who were hospitalized and 1.10 (95% CI, 0.71-1.72; P = .66) for women who were not.

Conclusions and Relevance Among women with singleton births in Nordic countries, no significant association was found between use of SSRIs during pregnancy and risk of stillbirth, neonatal mortality, or postneonatal mortality. However, decisions about use of SSRIs during pregnancy must take into account other perinatal outcomes and the risks associated with maternal mental illness.

Par ailleurs..
le Pr Antoine Pélissolo, psychiatre au CHU de la Pitié-Salpêtrière à Paris :
  • Certains obstétriciens recommandent d'arrêter les antidépresseurs au moment de l'accouchement, c'est ridicule.
  • La plupart des inhibiteurs sélectifs de la recapture de la sérotonine passent dans le lait maternel. Leur toxicité pour l’enfant n’est pas clairement démontré mais, dans le doute, mieux vaut limiter les éventuels risques. Les femmes qui souhaitent allaiter peuvent néanmoins prendre deux molécules qui ne posent pas de problème, la sertraline et la paroxétine.
  • En cas de trouble bipolaire, est-il possible de continuer à prendre son traitement ? Dans ce cas, la situation est beaucoup plus délicate. En effet, la grande majorité des médicaments prescrits sont contre-indiqués pendant la grossesse. [Texte complet / Lire]
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