Association between maternal antidepressant use and birth defects
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Association between maternal antidepressant use and birth defects There are some associations between the use of various antidepressants during pregnancy and the occurrence of specific birth defects in the offspring, according to study results reported in JAMA Psychiatry, although the results suggest that "confounding by underlying conditions should be considered when assessing risk". The population-based National Birth Defects Prevention Study (NBDPS) involved multiple US sites between October 1997 and December 2011. Surveillance systems identified 30 630 mothers of infants with birth defects who were compared with 11 478 controls. Computer-assisted telephone interviews were conducted 1.5–24 months after the expected due date. Antidepressant use during early pregnancy (a month prior to conception to gestational month 3) was reported for 1562 cases (5.1%) and 467 controls (4.1%). Compared with controls, use of the SSRI escitalopram was not associated with a significantly increased incidence of any evaluated birth defects. The risk of significantly increased specific birth defect-drug pairs was higher for paroxetine (adjusted odds ratio [aOR] 2.10–4.76) and fluoxetine (aOR 2.04–4.08) than for citalopram (aOR 1.56–3.01) or sertraline (aOR 2.79–3.32). For other antidepressants, bupropion was associated with some significantly increased risks (aOR 2.08–2.77), and venlafaxine was associated with significantly increased risks of a variety of birth defects (aOR 2.09–5.26). Compared with the 349 mothers of cases and 125 controls who only used antidepressants outside of early pregnancy, many of the significantly increased risks for birth defect-SSRI pairs were attenuated. However, there were increased risks of coarctation of the aorta with fluoxetine and atrioventricular septal defect with citalopram. The risk of diaphragmatic hernia with bupropion remained significantly elevated. Most birth defect-venlafaxine pairs had persistently elevated or even increased risks. "Our findings suggest varied risks for specific birth defects after early pregnancy use of individual SSRIs, venlafaxine, and bupropion, all of which are first-line antidepressants", note the authors, which "underscore the importance of research on the relative reproductive and fetal safety of all first-line antidepressants". They add that "for women who require antidepressants during pregnancy, relative differences in the safety of specific medications may be useful to consider in risk-benefit decision-making". Anderson KN, et al. Maternal Use of Specific Antidepressant Medications During Early Pregnancy and the Risk of Selected Birth Defects. JAMA Psychiatry : 5 Aug 2020. 803498335 Available from: URL: https://doi.org/10.1001/jamapsychiatry.2020.2453
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Reactions 29 Aug 2020 No. 1819
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