title: Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study.
abstract: OBJECTIVE
  To estimate risks of major congenital anomaly (MCA) among children of mothers prescribed antidepressants during early pregnancy or diagnosed with depression but without antidepressant prescriptions.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Linked UK maternal-child primary care records.
  
  
  METHODS
  A total of 349,127 singletons liveborn between 1990 and 2009.
  
  
  METHODS
  Odds ratios adjusted for maternal sociodemographics and comorbidities (aORs) were calculated for MCAs, comparing women with first-trimester selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) and women with diagnosed but unmedicated depression, or women without diagnosed depression.
  
  
  METHODS
  Fourteen system-specific MCA groups classified according to the European Surveillance of Congenital Anomalies and five specific heart anomaly groups.
  
  
  RESULTS
  Absolute risks of MCA were 2.7% (95% confidence interval, 95% CI, 2.6-2.8%) in children of mothers without diagnosed depression, 2.8% (95% CI 2.5-3.2%) in children of mothers with unmedicated depression, and 2.7% (95% CI 2.2-3.2%) and 3.1% (95% CI 2.2-4.1%) in children of mothers with SSRIs or TCAs, respectively. Compared with women without depression, MCA overall was not associated with unmedicated depression (aOR 1.07, 95% CI 0.96-1.18), SSRIs (aOR 1.01, 95% CI 0.88-1.17), or TCAs (aOR 1.09, 95% CI 0.87-1.38). Paroxetine was associated with increased heart anomalies (absolute risk 1.4% in the exposed group compared with 0.8% in women without depression; aOR 1.78, 95% CI 1.09-2.88), which decreased marginally when compared with women with diagnosed but unmedicated depression (aOR 1.67, 95% CI 1.00-2.80).
  
  
  CONCLUSIONS
  Overall MCA risk did not increase with maternal depression or with antidepressant prescriptions. Paroxetine was associated with increases of heart anomalies, although this could represent a chance finding from a large number of comparisons undertaken.
authors.affiliation: Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Ban
authors.forename: J E
authors.initials: JE
authors.lastname: Gibson
authors.forename: J
authors.initials: J
authors.lastname: West
authors.forename: L
authors.initials: L
authors.lastname: Fiaschi
authors.forename: R
authors.initials: R
authors.lastname: Sokal
authors.forename: L
authors.initials: L
authors.lastname: Smeeth
authors.forename: P
authors.initials: P
authors.lastname: Doyle
authors.forename: R B
authors.initials: RB
authors.lastname: Hubbard
authors.forename: L J
authors.initials: LJ
authors.lastname: Tata
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011446:Prospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Antidepressants; SSRIs; TCAs; congenital anomaly; depression