Use of selective serotonin-reuptake inhibitors in pregnancy and the risk of birth defects.
BACKGROUND
Information regarding the safety of selective serotonin-reuptake inhibitors (SSRIs) in human pregnancy is sparse. Concern has been raised about the risk of congenital heart defects associated with the use of SSRIs in pregnancy.


METHODS
We obtained data on 9622 case infants with major birth defects and 4092 control infants born from 1997 through 2002 from the National Birth Defects Prevention Study. Case infants were ascertained through birth-defects surveillance systems in eight U.S. states; controls were selected randomly from the same geographic areas. Mothers completed a standardized telephone interview regarding exposure to potential risk factors, including medications, before and during pregnancy. Exposure to SSRIs was defined as treatment with any SSRI from 1 month before to 3 months after conception. Birth defects were assigned to 26 categories and subcategories.


RESULTS
There were no significant associations between maternal use of SSRIs overall during early pregnancy and congenital heart defects or most other categories or subcategories of birth defects. Maternal SSRI use was associated with anencephaly (214 infants, 9 exposed; adjusted odds ratio, 2.4; 95% confidence interval [CI], 1.1 to 5.1), craniosynostosis (432 infants, 24 exposed; adjusted odds ratio, 2.5; 95% CI, 1.5 to 4.0), and omphalocele (181 infants, 11 exposed; adjusted odds ratio, 2.8; 95% CI, 1.3 to 5.7).


CONCLUSIONS
Maternal use of SSRIs during early pregnancy was not associated with significantly increased risks of congenital heart defects or of most other categories of birth defects. Associations were observed between SSRI use and three types of birth defects, but the absolute risks were small, and these observations require confirmation by other studies.
Alwan
Sura
S
Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
Reefhuis
Jennita
J
Rasmussen
Sonja A
SA
Olney
Richard S
RS
Friedman
Jan M
JM
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D000757:Anencephaly / Q000139:chemically induced / Q000453:epidemiology; D016022:Case-Control Studies; D003398:Craniosynostoses / Q000139:chemically induced / Q000453:epidemiology; D003866:Depressive Disorder / Q000188:drug therapy; D005260:Female; D020139:Gastroschisis / Q000139:chemically induced / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000139:chemically induced* / Q000453:epidemiology; D006554:Hernia, Umbilical / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*
D017367:Selective Serotonin Reuptake Inhibitors