Safety of selective serotonin reuptake inhibitors in pregnancy

Allison Donnelly,Carol Paton

doi:10.1192/pb.bp.106.012898

Abstract

Aims and MethodSelective serotonin reuptake inhibitors (SSRIs) are recommended by the National Institute for Clinical Excellence as first-line drugs for the treatment of depression, but there is emerging evidence that they might not be entirely safe in pregnancy. We reviewed the literature in this area.ResultsSome data indicate an association between first-trimester SSRI exposure, particularly with paroxetine, and an increased risk of some major congenital malformations. Stronger evidence supports an association with small reductions in gestational age and neonatal withdrawal symptoms.Clinical ImplicationsRisks and benefits of using SSRIs during pregnancy should be discussed with the patient, and a joint decision made between prescriber and patient regarding treatment. Limited data suggest that other SSRIs are safer than paroxetine in pregnancy.

Highlights

Background risk of congenital malformationsThe background risk of congenital malformations is 2-3%; these figures are derived from a hospital-based surveillance study involving 69 277 births (Nelson &Holmes, 1989)
Some data indicate an association between first-trimester SSRI exposure, with paroxetine, and an increased risk of some major congenital malformations
In a database study that is currently only available in abstract form, Wogelius et al (2005) reported that the odds ratio for congenital malformations in 1054 infants exposed to an SSRI in the first trimester was 1.4 compared with infants not exposed to an SSRI in utero

Summary

Introduction

Background risk of congenital malformationsThe background risk of congenital malformations is 2-3%; these figures are derived from a hospital-based surveillance study involving 69 277 births (Nelson &Holmes, 1989). Some data indicate an association between first-trimester SSRI exposure, with paroxetine, and an increased risk of some major congenital malformations.

Results

Conclusion