title: Early pregnancy exposure to selective serotonin reuptake inhibitors, risks of major structural malformations, and hypothesized teratogenic mechanisms.
abstract: BACKGROUND
  Selective serotonin reuptake inhibitors (SSRIs) are commonly used to manage antenatal depression. Hence, the aim of this systematic review is to assess the prevalence of birth defects associated with pregnancy exposure to such agents and summarize the hypothesized teratogenic mechanisms.
  
  
  METHODS
  Medical literature published in English (1980 - June 2015) was electronically searched to identify all articles reporting an increased prevalence of birth defects associated with prenatal SSRI exposure and hypothesizing teratogenic mechanisms.
  
  
  CONCLUSIONS
  The only recurrent pattern of congenital anomalies associated with antenatal SSRI exposure is heart defects. SSRIs may alter the function of serotonin and related receptors which are involved in the development of the monoamine-dependent cardiac structures. Nevertheless, the magnitude of this increase and, thus, its clinical significance are unclear. Therefore, a cautious approach of using SSRI during pregnancy only in the case of major depressive episodes should be applied. However, this risk should be balanced against the risks associated with the worsening of depressive symptoms, and take into consideration the large number of studies that found no associations between transplacental SSRI exposure and cardiac anomalies. Prenatal ultrasonography and Doppler sonography to detect early cardiac defects are also advisable. Non-pharmacological approaches are preferred for less severe psychiatric disorders.
authors.affiliation: a 1 Mental Health Center Cava de' Tirreni - Vietri sul Marei, Department of Mental Health ASL Salerno , Piazza Galdi, Salerno, Cava de' Tirreni, 841013, Italy +39 089 4455439 ; +39 089 4455440 ; salvatore_gentile@alice.it.|b 2 University of Naples (Italy), Medical School "Federico II", Department of Neurosciences, Division of Psychiatry-Perinatal Psychiatry , Via s. Pansini, 5 80131 Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gentile
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: antidepressants; birth defects; pregnancy; selective serotonin reuptake inhibitors