A study in BMJ reports that an increased risk of birth defects was seen with use of some selective serotonin reuptake inhibitors (SSRIs) during early pregnancy, but that the absolute risk is still low if the association is indeed causal.

Researchers from the United States and Canada reviewed data from the U.S. National Birth Defects Prevention Study (NBDPS) of 17,952 mothers of infants with birth defects and 9,857 mothers of infants without birth defects (control group); all of the infants were born between 1997–2009. Use of the SSRIs citalopram, escitalopram, fluoxetine, paroxetine, or sertraline at least once in the period from one month before conception through the third month of pregnancy was noted along with previously reported birth defects linked to SSRI use (neural tube defects, anencephaly, all septal defects, ventricular septal defects, right ventricular outflow tract obstructions, cleft palate, cleft lip with or without cleft palate, esophageal atresia, anal atresia, hypospadias, any limb reduction defect, craniosynostosis, gastroschis, and omphalocele).

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Forty percent of the women who used an SSRI in early pregnancy were taking sertaline, but none of the previously reported associations were observed in this study. Significant associations were seen with paroxetine and anencephaly, atrial septal defects, right ventricular outflow tract obstruction defects, gastroschisis, and omphalocele, along with ventricular septal defects, right ventricular outflow tract obstruction cardiac defects, and craniosynostosis for fluoxetine. No other relationships between SSRI use and birth defects were noted.

The authors emphasize that this study cannot confirm a causal relationship between use of some SSRIs in early pregnancy and birth defects and that the absolute risk remains low. The findings do highlight a need for research to evaluate potential associations between specific SSRIs and individual birth defects. Clinicians may use these results to guide treatment for depression in early pregnancy while also reducing risk of major birth defects.

For more information visit BMJ.com.