The evidence is building for small but increased risks of birth defects in the offspring of women taking some selective serotonin reuptake inhibitor (SSRIs) antidepressants in early pregnancy, according to a study published in The BMJ
on 8 July 2015.
There has been discussion over the past decade about a link between the use of SSRIs in pregnant women and children born with defects, including heart problems.
To find out more about this connection, a team of researchers led by the US National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), combined findings from published papers and reports from the US National Birth Defects Prevention Study (NBDPS).
The researchers looked at records of 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects, born between 1997 and 2009.
Focusing on birth defects that have already been linked with use of SSRIs, the analysis found no links with use of citalopram or escitalopram. However, there were connections between the use of fluoxetine and heart wall defects or craniosynostosis (irregular skull shape). There was also evidence of a link between paroxetine (Paxil) and heart wall defects, anencephaly (missing brain, skull and scalp portions) or abdominal wall defects (gastroschisis and omphalocele).
Around 40% of women in the study had taken sertraline but there were no significant connections between this drug and birth defects.
The researchers emphasise that while there is evidence for these links, any increases in risk are very small, and it’s not clear yet whether the connection is causal or not.
Treating depression in early pregnancy is a fine line between keeping women safe and well, and protecting the unborn child. While this study suggests small increases in harm from some SSRIs, it could provide guidance to the safest treatment options during early pregnancy when treatment is absolutely necessary.
A spokesperson from the Newlife Foundation, a UK charity working with disabled children, says: “As a general rule, medication should be avoided in pregnancy where possible as there are a few examples where medication may have an adverse effect on the baby. In situations where it is essential for the mother’s health, the medication should be supervised by the patient’s own doctor.”
 Reefhuis J, Devine O, Friedman JM et al. Specific SSRIs and birth defects: bayesian analysis to interpret new data in the context of previous reports. The BMJ 2015;351:h3190. doi:10.1136/bmj.h3190 .