Study Examines Association Between SSRIs, Birth Defect Risks

Prenatal use of sertraline may not pose the risk of birth defects in offspring that some previous reports have suggested, according to a study published this week in BMJ.

To estimate the association between prenatal use of selective serotonin reuptake inhibitors (SSRIs) and previously reported offspring birth defects that have been linked to such drug use, researchers from the Centers for Disease Control and Prevention, the University of British Columbia, and Boston University analyzed data from the U.S. National Birth Defects Prevention Study. This analysis included the records of approximately 18,000 mothers of infants with birth defects and 10,000 mothers of infants without birth defects, focusing on the use of citalopram, escitalopram, fluoxetine, paroxetine, or sertraline that occurred at least once in the period from one month prior to conception through the end of the first trimester of pregnancy.

The results showed that though sertraline was the most commonly used SSRI among study participants, none of the five previously reported associations between prenatal use of the drug and birth defects in offspring were confirmed. Additionally, no association with maternal use of citalopram or escitalopram monotherapy was found, except for a marginal association between citalopram and neural tube defects. However, the analysis did confirm heart wall defects and craniosynostosis associated with fluoxetine treatment as well as five previously reported birth defects associated with paroxetine use, including heart defects, problems with brain and skull formation, and abdominal wall effects.

The researchers concluded that “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 health care providers to make more informed decisions about treatment.”

For more information on the prenatal use of SSRIs, see the Psychiatric News article “Certain Cardiac Abnormalities Not Linked to Prenatal Antidepressant Use, Study Finds” and the American Journal of Psychiatry study “SSRI Use During Pregnancy and Risk of Stillbirth and Neonatal Mortality.”

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