Certain SSRI Antidepressants Linked to Birth Defects

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Taking certain selective serotonin reuptake inhibitors (SSRIs) in the early stages of pregnancy for depression may lead to an increased risk of birth defects, while other SSRIs appear to not share that risk.

Jennita Reefhuis, PhD, of the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention, and colleagues examined results from independent analyses that included data from the US National Birth Defects Prevention Study.

The team’s new analysis comprised 17,952 women who had children with birth defects, and 9,857 mothers whose children had no defects. All the children were born between 1997 and 2009. If the mothers took the SSRIs citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) one or more times one month before conception through the third month of pregnancy, that was noted. Sertraline was the most commonly used SSRI among the women.

Maternal use of paroxetine was associated with five birth defects, including heart defects, brain and skull formation (anencephaly), and abdominal wall defects, the researchers reported in the journal The BMJ. Also, use of fluoxetine was linked to an increased risk of heart wall defects and irregular skull shape (craniosynostosis).

However, while existing research had indicated an association between sertraline and birth defects, the new analysis found no such link.

“Although our analysis strongly supports the validity of the associations that were observed, the increase in the absolute risks, if the associations are causal, is small,” the researchers said in a statement. “Continued scrutiny of the association between SSRIs and birth defects is warranted and additional studies of specific SSRI treatments during pregnancy are needed to enable women and their healthcare providers to make more informed decisions about treatment.”

Impact of Depression Treatment During Pregnancy Unclear
Maternal use of paroxetine (Paxil) and fluoxetine (Prozac) was associated with a higher risk of birth defects, but not with sertraline (Zoloft).

In recent years, numerous studies have reported that there may be a link between maternal use of a class of antidepressants known as selective serotonin reuptake inhibitors and greater risk of birth defects. Now, a new study provides further evidence of this association.

The study reveals that women who used certain selective serotonin reuptake inhibitors (SSRIs) for depression in early pregnancy were more likely to have offspring with heart problems and abnormal brain and skull formation, among other birth defects.

Study co-author Jennita Reefhuis, of the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC), and colleagues publish their findings in The BMJ.

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