Antidepressant prescriptions, discontinuation, depression and perinatal outcomes, including breastfeeding: A population cohort analysis

PLoS One. 2019 Nov 18;14(11):e0225133. doi: 10.1371/journal.pone.0225133. eCollection 2019.


Objectives: To explore associations between exposure to antidepressants, their discontinuation, depression [medicated or unmediated] and preterm birth [<37 and <32 weeks], small for gestational age (SGA) [<10th and <3rd centiles], breastfeeding [any] at 6-8 weeks.

Methods: Design: A population-based cohort study. Setting: The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes. Participants: 107,573, 105,331, and 38,725 infants born 2000-2010 with information on prematurity, SGA and breastfeeding respectively, after exclusions. Exposures: Maternal antidepressant prescriptions in trimesters 2 or 3, discontinuation after trimester 1, recorded diagnosis of depression [medicated or unmediated] in pregnancy. Methods: Odds ratios for adverse pregnancy outcomes were calculated, adjusted for smoking, parity, socio-economic status, and depression.

Results: Exclusive formula feeding at 6-8 weeks was associated with prescriptions in trimesters 2 or 3 for any antidepressants (adjusted odds ratio [aOR] 0.81, 95% confidence intervals 0.67-0.98), SSRIs [aOR 0.77, 0.62-0.95], particularly higher doses [aOR 0.45, 0.23-0.86], discontinuation of antidepressants or SSRIs after trimester 1 (aOR 0.70, 0.57-0.83 and 0.66, 0.51-0.87), diagnosis of depression aOR 0.76 [0.70-0.82), particularly if medicated (aOR 0.70, 0.58-0.85), rather than unmedicated (aOR 0.87, 0.82-0.92). Preterm birth at <37 and <32 weeks' gestation was associated with diagnosis of depression (aOR 1.27, 1.17-1.38, and 1.33, 1.09-1.62), particularly if medicated (aOR 1.56, 1.23-1.96, and 1.63, 0.94-2.84); birth at <37 weeks was associated with antidepressants, (aOR 1.24, 1.04-1.49]. SGA <3rd centile was associated with antidepressants (aOR 1.43, 1.07-1.90), and SSRIs (aOR 1.46, 1.06-2.00], particularly higher doses [aOR 2.10, 1.32-3.34]. All adverse outcomes were associated with socio-economic status and smoking.

Implications: Exposure to antidepressants or depression increased risks of exclusive formula feeding at 6-8 weeks, and prescription of antidepressants was associated with SGA <3rd centile. Prescription of antidepressants offers a useful marker to target additional support and additional care before and during pregnancy and lactation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antidepressive Agents* / administration & dosage
  • Birth Weight
  • Breast Feeding*
  • Cohort Studies
  • Depression / epidemiology*
  • Depression / etiology*
  • Depression, Postpartum / epidemiology
  • Depression, Postpartum / etiology
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Odds Ratio
  • Population Surveillance
  • Pregnancy
  • Premature Birth / epidemiology


  • Antidepressive Agents

Grant support

This paper was developed from the EUROmediCAT project, and uses the cohort identified in that project. The analyses presented here were completed outside the funded period. Financial support for the EUROmediCAT study was provided by the European Union under the 7th Framework Program [grant agreement HEALTH-F5-2011-260598]. Start date: 1 March 2011. Duration: 48 months. Coordinator Prof. Helen Dolk, University of Ulster. Further information can be found at The paper is based on data in the all-Wales SAIL databank, which is supported by UK Research and Innovation funding to Swansea University through an Administrative Data Research Centre grant (2018-2921), project reference: ES/S007393/1, Principal Investigator: Professor David Ford.