SSRIs during first trimester increase risk of congenital anomalies

Exposure to fluoxetine and paroxetine in early pregnancy is associated with a small but established risk of specific cardiac anomalies, according to a study published in the July issue of Obstetrics and Gynecology.

The retrospective study analyzed a cohort of 635,583 offspring, of whom 6,976 had first trimester exposure to selective serotonin reuptake inhibitors (SSRIs). Researchers gathered information from National Institute for Health and Welfare (years 1996 to 2006) of births, congenital anomalies, and terminations of pregnancy because of severe fetal anomalies, and from the Social Insurance Institution on drug reimbursements linked by a personal identification number.

The study demonstrated that fluoxetine in early pregnancy was associated with an increased risk for isolated ventricular septal defects (adjusted OR=2.03; 95% CI, 1.28 –3.21) and paroxetine was associated with an increased risk of right ventricular outflow tract defects (adjusted OR=4.68; 95% CI, 1.48–14.74). Citalopram use was associated with neural tube defects (adjusted OR=2.46; 95% CI, 1.20–5.07). And, fetal alcohol spectrum disorders were 10 times more common in the SSRI-exposed offspring than in unexposed referent offspring.

“These findings should guide clinicians to not consider fluoxetine or paroxetine as the first options when prescribing these drugs to women planning pregnancy. Special attention should be given to alcohol use, smoking, and use of other psychiatric drugs in pregnant women using selective serotonin reuptake inhibitors,” the authors wrote and noted that their findings need to be confirmed in future studies.