New research reveals that SSRIs are not major causes for the malformation of a developing fetus. SSRIs (Selective Serotonin Reuptake Inhibitors) are often prescribed for depression, a relatively common condition among women. Previous reports had suggested that use of SSRIs (particularly Paxil and Paxil CR) during early pregnancy is associated with an increased risk for heart defects. Reports from two large ongoing case control studies provide new data on the risks associated with prenatal exposure to SSRIs.
Investigators from the Centers for Disease Control (CDC) and the University of British Columbia studied 9,622 case infants with major birth defects (identified through birth defect surveillance systems in eight states) and 4,092 controls born from 1997 through 2002. Overall, the authors observed no significant associations between maternal SSRI use during early pregnancy and congenital heart defects or most other categories of birth defects. Specifically, maternal SSRI use was associated with anencephaly (odds ratio, 2.4) craniosynostosis (odds ratio 2.5), and omphalocele (odds ratio 2.8).
The use of Paxil correlated with a higher pooled odds ratio for the birth defects of craniosynostosis (restricted skull growth), omphalocele (abdominal wall defect caused by fetal abnormality), and anencephaly (a major portion of the brain is reduced or absent) for these three major birth defects and with a significantly increased risk for right ventricular outflow tract obstruction defects.
In a second study, investigators funded by the makers of Paxil and by the National Institute of Health (NIH) studied 9,849 case infants and 5,860 controls born in the United States and Canada from 1993 through 2005. Overall, SSRI use was not associated with risk for heart defects, craniosynostosis, or omphalocele. However, Paxil use correlated with a significantly increased risk for right ventricular outflow tract obstruction defects.
The authors of both studies pointed out that the absolute risks associated with SSRI use during pregnancy were small in relation to the risk for birth defects in the general population.
These two new reports clarify that SSRIs are not major causes of birth defects. This information plus the knowledge of the risks associated with discontinuing an SSRI during pregnancy should help women make decisions relative to managing depression. For women taking SSRIs during early pregnancy, targeted second trimester ultrasound makes sense. Women who choose to discontinue their SSRIs during or just before pregnancy will likely benefit from psychiatric monitoring be required.
Source: Journal Watch Women's Health
