SSRIs and Birth Defects

Abstract

increased risk tend to receive more me dia attention,2 it is particularly important that they be rigorously conducted and the findings and conclusions carefully analyzed and presented. We feel that the authors over stepped the limitations of the study methodology with some of their conclu sions for the following reasons: 1) There was no pattern of specific defects, and this lack of specificity is generally con sidered an indication that teratogenicity is an unlikely explanation. 2) There was no separation of major versus minor congenital anomalies, and minor anom alies, by definition, cause no functional impairment.3 This distinction is of the utmost clinical importance, and omitting it from the analyses markedly limits the clinical usefulness of the study's data. 3) As this was a prescription-events moni toring study, it was not known whether the medications were actually taken by the women. 4) Psychiatrically-ill patients frequently use other psychotropic medi cations, alcohol and illicit drugs, and these potential confounders were not ad dressed in this study. 5) Finally, there was no control for maternal illness. This is of great importance because exposure of a fetus to antenatal maternal depres sion, stress or anxiety may have direct adverse effects on the offspring.4 Major depression when untreated may result in dangerous self-neglect, with disorganized thoughts and behavior. This is particularly worrying during pregnancy, for it may result in smaller babies, preterm labor, and other obstetrical difficulties.5 Vivien Burt The Women's Life Center of The Semel Institute for Neuroscience and Human Behaviour Geffen School of Medicine at UCLA Los Angeles, CA Laura Miller Department of Psychiatry University of Illinois Chicago, IL Adrienne Einarson The Motherisk Program The Hospital for Sick Children Toronto, Canada einarson@sickkids.ca