Antidepressant use during early pregnancy and the risk of congenital anomalies

Catherine Vasilakis-Scaramozza, Ann Aschengrau, Howard Cabral, Susan S Jick
Pharmacotherapy 2013, 33 (7): 693-700

STUDY OBJECTIVE: To estimate and compare the prevalence of congenital anomalies among the offspring of women exposed and not exposed to antidepressants during early pregnancy.

DESIGN: Matched cohort study.

DATA SOURCE: United Kingdom's General Practice Research Database.

SUBJECTS: Women exposed to tricyclic and selective serotonin reuptake inhibitor (SSRI) antidepressants during the first trimester of pregnancy (3276 women) and a sample of women matched in a 2:1 ratio who had no exposure to any antidepressant during the first trimester of pregnancy (6617 women).

MEASUREMENTS AND MAIN RESULTS: The prevalence of any congenital anomaly was 31.0 (95% confidence interval [CI] 27.0-35.5) per 1000 pregnancies among women not exposed to antidepressants and 27.2 (95% CI 22.1-33.4) per 1000 pregnancies among women exposed to antidepressants. The relative risk of having a child with an anomaly in mothers who were exposed to tricyclics and SSRIs during the first trimester compared with mothers not exposed to these drugs was 0.9 (95% CI 0.7-1.1). The relative risks for any anomaly among women exposed to antidepressants were 0.9 (95% CI 0.6-1.2) for tricylics and 0.9 (95% CI 0.7-1.2) for SSRIs. We found no statistically significant, stable increases in the risk of specific anomaly subtypes among women exposed to these antidepressants; however, the number of exposed cases was small.

CONCLUSION: Exposure to tricyclics and SSRIs during the first trimester of pregnancy was not associated with a statistically significant increased risk of congenital anomalies in the offspring of mothers exposed to these drugs.

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