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Selective Serotonin Reuptake Inhibitors and Congenital Heart Anomalies: Comparative Cohort Studies of Women Treated Before and During Pregnancy and Their Children

J Clin Psychiatry 2016;77(1):e36–e42

Background: Large databases and population registers are increasingly used to examine adverse birth outcomes, congenital heart anomalies, in particular, following antidepressant exposures in pregnancy. Yet many studies have failed to account for other characteristics of the women who were prescribed antidepressants.

Objective: To examine the characteristics of women who are prescribed selective serotonin reuptake inhibitors (SSRIs) in pregnancy and women who are not, associations between SSRIs prescribed in pregnancy and congenital heart anomalies, and the association between social and lifestyle characteristics of pregnant women and congenital heart anomalies.

Method: Using data from The Health Improvement Network primary care database in the United Kingdom between January 1, 1990, and January 31, 2011, we set up a comparative study including 4 cohorts of children of women with and without different antidepressant exposures before and during pregnancy. 5,154 women were receiving SSRIs before pregnancy, 2,776 were receiving SSRIs during pregnancy, 992 were receiving other antidepressants during pregnancy, and 200,213 were receiving no antidepressants before or during pregnancy. Our primary outcome was congenital heart anomalies.

Results: Less than 1% of children had a record of congenital heart anomalies within 5 years of birth, and there were no significant differences related to antidepressant exposure in pregnancy (women not prescribed antidepressants versus women prescribed SSRIs in first trimester: odds ratio [OR] = 1.00; 95% CI, 0.65–1.52); however, independent of antidepressant prescribing, diabetes (OR = 2.23; 95% CI, 1.79–2.77), increasing age (OR = 1.01; 95% CI, 1.00–1.02), alcohol problem (OR = 2.58; 95% CI, 1.55–4.29, illicit drug problems (OR = 1.89; 95% CI, 1.09–3.25), and obesity (OR = 1.38; 95% CI, 1.13–1.69) were associated with an increased risk of having a child with congenital heart anomalies.

Conclusions: There was no difference in congenital heart anomalies in children born to women with different antidepressant prescribing exposure status. However, we confirmed an increased risk of congenital heart anomalies in children of older women and in children of women with diabetes, a body mass index above 30 kg/m2, and a history of alcohol and illicit drug problems independent of the prescription of antidepressants. Future research in this field must account for these characteristics. On the basis of existing evidence, advising women to stop antidepressant treatment in pregnancy may be counterproductive.