Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy.
OBJECTIVE
To evaluate risks for perinatal complications and congenital defects among infants exposed in utero to antidepressants.


METHODS
We identified 2201 women who were prescribed an antidepressant during pregnancy and who delivered an infant within one of five large managed care organizations (HMO). Prescription drug dispensings and inpatient and outpatient diagnoses were obtained from automated databases at each HMO. Antidepressants were categorized into tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and medication timing was assessed by trimester. Rates of congenital anomalies or perinatal complications were compared to infants whose mothers were not prescribed antidepressants during pregnancy.


RESULTS
Infants exposed to SSRIs or TCAs during pregnancy had a significant increase in preterm delivery risk. Fullterm infants exposed to SSRIs during the third trimester had an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, hypoglycemia, temperature regulation disorders, and convulsions. Third-trimester exposure to TCAs was also associated with an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, and temperature regulation disorders. There were 182 infants exposed to Paroxetine, and these infants did not have an increased risk of cardiac septal defects.


CONCLUSIONS
SSRIs and TCAs did not show a consistent link with congenital anomalies. Paroxetine exposure was not linked with an increased risk for cardiovascular anomalies, although our study power to detect a moderate increase in risk was limited. Infants exposed to antidepressants were at increased risk for preterm delivery. Both SSRIs and TCAs used during the third trimester appeared to increase the risk for perinatal complications and their use should be managed carefully among pregnant women with depression.
Davis
Robert L
RL
Center for Health Studies, Group Health Cooperative, Seattle, WA, USA. robert.l.davis@kp.org
Rubanowice
David
D
McPhillips
Heather
H
Raebel
Marsha A
MA
Andrade
Susan E
SE
Smith
David
D
Yood
Marianne Ulcickas
MU
Platt
Richard
R
D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000928:Antidepressive Agents / Q000009:adverse effects*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D007752:Obstetric Labor, Premature / Q000139:chemically induced; D011247:Pregnancy; D012189:Retrospective Studies; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects
D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors