ACOG Statement on the Benefit of Access to SSRIs During Pregnancy

The following is a statement from Steven J. Fleischman, MD, MBA, FACOG, president of the American College of Obstetricians and Gynecologists (ACOG):

“Today’s FDA panel on SSRIs and pregnancy was alarmingly unbalanced and did not adequately acknowledge the harms of untreated perinatal mood disorders in pregnancy. On a panel of 10 experts, only one spoke to the importance of SSRIs in pregnancy as a critical tool, among others, in preventing the potentially devastating effects of anxiety and depression when left untreated during pregnancy.

“Robust evidence has shown that SSRIs are safe in pregnancy and that most do not increase the risk of birth defects. However, untreated depression in pregnancy can put our patients at risk for substance use, preterm birth, preeclampsia, limited engagement in medical care and self-care, low birth weight, impaired attachment with their infant, and even suicide. Data also show that discontinuing SSRIs due to pregnancy or lactation can carry risks. Patients need access to evidence-based, compassionate treatment options so that they can continue their paths to parenthood in sound physical and mental health. 

“For pregnant people who need SSRIs, they are life-changing and lifesaving. Mental health conditions are already the most frequent cause of pregnancy-related death. Unfortunately, the many outlandish and unfounded claims made by the panelists regarding SSRIs will only serve to incite fear and cause patients to come to false conclusions that could prevent them from getting the treatment they need.

“One false accusation that was repeated often during the meeting was that patients are deceived or are inadequately counseled by their doctors when it comes to the real effects of SSRIs. Patients who choose to continue taking SSRIs during pregnancy with the support of their ob-gyns do so following counseling on the risks and benefits that includes discussion of the data and consideration of their own needs, values and priorities.

“ACOG agrees with the panel’s assertion that randomized trials to assess the safety of SSRIs have not been conducted and should be prioritized. ACOG has consistently advocated for the inclusion of pregnant people in clinical trials to help ensure the safety and efficacy of medication taken during pregnancy, and was very supportive of the efforts by FDA and the Eunice Kennedy Shriver National Institute of Child Health and Human Development to establish working groups for the Prioritization of Therapeutic Research Needs for Pregnant, Postpartum, and Lactating Persons. SSRIs were slated to be one of those working groups. However, that work has now been stalled due to the administration’s recent significant cuts to the NIH. Medications to treat mental health conditions, such as SSRIs, were slated to be one of those working groups.

“It is dangerous to minimize the real effects from mental health conditions during pregnancy and postpartum. For the sake of our patients, ACOG continues to assert that all treatment options should be available for people struggling with their mental health during pregnancy.”