Gideon Koren, MD
Does use of selective serotonin reuptake inhibitors (SSRIs) in the first trimester of pregnancy increase risk for congenital malformations?
Population-based cohort study based on linked data from 4 national registries.
496 881 singleton live-born children born from 1996 to 2003. Children were excluded if they had been exposed in utero to insulin, antihypertensive drugs, psychotropic drugs, or antidepressants other than SSRIs; or were lost to follow-up because of emigration.
Filling ≥ 2 prescriptions for an SSRI by the mother between 28 days before and 112 days after the beginning of gestation.
Congenital malformations (diagnosed at ≤ 1 y of age) coded according to the European Surveillance of Congenital Anomalies (Eurocat) categorization with further subcategorization of congenital heart defects.
SSRIs taken during the first trimester of pregnancy did not increase risk for major congenital malformations, noncardiac malformations, or major cardiac malformations but did increase the absolute risk for septal heart defects by 0.4% (number needed to harm 246) (Table). Septal heart defects were increased in the children of mothers who took citalopram, sertraline, or > 1 type of SSRI but not in the children of those who took fluoxetine or paroxetine.
Selective serotonin reuptake inhibitors taken in the first trimester of pregnancy were not associated with increased risk for major congenital malformations overall but were associated with increased risk for septal heart defects.
Exposure to selective serotonin reuptake inhibitors during early pregnancy and risk for congenital malformation in the offspring
*Adjusted for maternal age, calendar year, income, marital status, and smoking status.
Koren G. SSRIs in early pregnancy were associated with increased risk for septal heart defects but not major congenital malformations overall. Ann Intern Med. 2009;151:JC6–15. doi: 10.7326/0003-4819-151-12-200912150-02015
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Published: Ann Intern Med. 2009;151(12):JC6-15.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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