Untreated maternal depression has been shown to have adverse effects in many children, yet how the mother should be treated is not clear and can vary with the situation. The use of selective serotonin reuptake inhibitors (SSRIs) during the first trimester of pregnancy carries with it potential risk of congenital cardiac malformation, but individual studies and systematic analyses vary in their results.
A literature search was performed using MEDLINE-Ovid, Web of Science, Cochrane, and Google Scholar using the terms “SSRI,” “pregnancy,” and “birth defect.” The term “birth defect” was used rather than a term more specific to the heart (e.g. “cardiac malformation”) in order to keep the search sufficiently broad. The search was further restricted to studies published in the English language between 2010 and 2015. The MEDLINE search also included the terms “serotonin uptake inhibitors,” “pregnancy outcomes,” and “congenital abnormalities.” In addition to database searches, bibliographies from select journal articles were reviewed for potential sources of relevant articles. Articles were assessed using GRADE criteria (www.gradeworkinggroup.org).
Two studies were found which met the inclusion and exclusion criteria, one from the US and the other from the UK, both of which were cohort studies. There was no significant increase of risk regarding exposure to SSRIs as a class of medication in either study. The RR for general SSRI exposure in the US study was 1.02 (95% CI, 0.90–1.15). The aOR for overall SSRI exposure in the UK study ranged from 1.03 to 1.14. There was a significant increase of risk with paroxetine exposure in the UK study, evidenced by an aOR of 1.78 (95% CI, 1.09–2.88).
The studies demonstrated low risk of congenital cardiac malformation with exposure to SSRIs as a general class. However, paroxetine and sertraline exposure showed elevated risk that was sometimes considered significant. The decision to treat maternal depression with SSRIs should involve recent and reliable literature, as well as involve the patient.
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