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More About SSRI Use During Pregnancy

A population-based cohort study reports SSRI-associated cardiac septal defects.

Recent studies have reported that exposure to SSRIs during pregnancy is associated with increased rates of malformations, such as omphalocele, craniosynostosis, and cardiac defects, although the literature is mixed and inconsistent. In a new epidemiological study, researchers used nationwide Danish registries covering 496,881 singleton liveborn children (birth years, 1996–2003) to examine malformation rates with SSRIs.

The cohort included 1370 children with mothers who filled two or more prescriptions for an SSRI and none for other psychotropic medications, insulin, or antihypertensives, from 28 days before conception to 112 days afterward. The authors controlled for confounders such as smoking and maternal age but not for effects or severity of depression. Compared with nonexposure, SSRIs were not associated with major malformations overall but were significantly associated with cardiac septal defects (odds ratios: all SSRIs, 1.99; sertraline, 3.25; citalopram, 2.52). Absolute rates were 0.5% with no exposure, 0.9% with single-SSRI exposure, and 2.1% with exposure to more than one type of SSRI (absolute numbers: 2315, 12, and 4, respectively).

Comment: An editorialist points out that few children in this study were potentially SSRI-exposed; that studies have been inconsistent in finding specific SSRI-associated defects; and that even if other studies bear out the doubling of risk for cardiac septal defects with an SSRI prescription, the risk remains low (0.9%). For clinicians, this study raises yet more questions, and no definitive answers, regarding risks of SSRI use during pregnancy. Concerns about possible increases in the risk for cardiac septal defects must be weighed against the risks of maternal depression for both the mother and the child. The recent APA-ACOG algorithms provide helpful guidance for clinicians treating depression during pregnancy (JW Psychiatry Sep 28 2009).

— Deborah Cowley, MD

Published in Journal Watch Psychiatry October 19, 2009

Citation(s):

Pedersen LH et al. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: Population based cohort study. BMJ 2009 Sep 23; 339:b3569. (http://dx.doi.org/10.1136/bmj.b3569)

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Chambers C. Selective serotonin reuptake inhibitors and congenital malformations. BMJ 2009 Sep 23; 339:b3525. (http://dx.doi.org/10.1136/bmj.b3525)

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• Medline abstract (Free)