Use of selective serotonin reuptake inhibitors during pregnancy and disorganised infant–mother attachment

Abstract

Objective: To examine the quality of infant–mother attachment in a prospective case series of infants whose mothers took selective serotonin reuptake inhibitors (SSRIs) during pregnancy. Background: SSRIs are prescribed to 2–6% of pregnant women. Recent articles on the use of SSRIs during pregnancy note the increased risk for problematic infant–mother relationships among mothers with untreated postpartum depression. However, little is known about the quality of infant–mother relationships among mothers who took SSRIs during pregnancy. Methods: Five mothers who took SSRIs during pregnancy were recruited from a community study of infant development. Mothers completed ratings of postpartum depression symptoms (Beck Depression Inventory) 4–6 times between 1 month and 1 year following the infant’s birth. At 1 year postpartum, quality of infant–mother attachment was assessed using the strange situation procedure. Results: Four of the five infant–mother dyads (80%) were classified as disorganised, a rate considerably higher than in postpartum depression samples. Conclusion: These results are used to raise questions about the clinical implications of research on in utero exposure to SSRIs, perinatal depression, and disorganised attachment. Specifically, this case series raises questions about using research on the link between postpartum depression and infant–mother attachment as a rationale for the use of SSRIs during pregnancy. Current research indicates use of SSRIs during pregnancy may: (1) increase risk for disorganised attachment, (2) decrease risk for disorganised attachment, or (3) have no effect on disorganised attachment.

Keywords:

• attachment
• postnatal depression
• pregnancy
• SSRIs

Acknowledgements

This research was supported by grants from the FHL Foundation, the National Institute of Child Health and Human Development (NICHD) (R03 HD37232-02), and the University of Iowa (international travel grant, College of Medicine research award, Children’s Miracle Network grant, Iowa Center for Research by Undergraduates, and Obermann Center for Advanced Studies Spelmann Rockefeller grant) to Beth Troutman.

We are grateful to Rick Leonhardt, Kate Hancock and Betty Simon for consultation and support, the mothers and infants who participated in this study, and the research assistants who assisted with recruitment, data collection and data entry. Portions of these data were presented at the Marce Society International Biennial Scientific Meeting, Oxford University, UK, September 2004.