Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study

Abstract

Aims: To examine the association between late pregnancy exposure to serotonin reuptake inhibitor (SRI) antidepressants and difficulties in achieving an adequate breast milk supply in women who gave birth to preterm infants, while accounting for the potential impacts of underlying maternal psychiatric illness. Methods: Retrospective cohort study of 3,024 women delivering liveborn preterm infants (<37 weeks' gestation) between January 2004 and December 2008. The primary outcome was postnatal domperidone use, considered a valid proxy for presence and pharmacological management of low milk supply. Relative risks adjusted for maternal soiodemographics and comorbidities (aRRs) were calculated for low milk supply, comparing women with late pregnancy exposure to SRI antidepressants (n = 86), women with a psychiatric illness but no antidepressant use (n = 126), and women with neither antenatal exposures (n = 2 812). Results: Compared to non-exposed women, non-medicated psychiatric illness (aRR 1.64; 95%CI 1.16-2.30) but not late pregnancy SRI use (aRR 1.00; 95%CI 0.59-1.70) was associated with an increased risk of domperidone use, indicative of low milk supply. Conclusions: These findings do not support the previously observed negative impacts of antidepressant use on breastfeeding, instead suggesting that women with an underlying psychiatric illness appear at greatest risk of experiencing low milk supply and could benefit from additional breastfeeding education and support.