Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Bech BH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. BMJ 339: b3569

Department of Epidemiology, Institute of Public Health, Aarhus University, Bartolin Allé 2, DK-8000 Aarhus, Denmark.
BMJ (online) (Impact Factor: 17.45). 09/2009; 339(sep23 1):b3569. DOI: 10.1136/bmj.b3569
Source: PubMed


To investigate any association between selective serotonin reuptake inhibitors (SSRIs) taken during pregnancy and congenital major malformations.
Population based cohort study.
493 113 children born in Denmark, 1996-2003.
Major malformations categorised according to Eurocat (European Surveillance of Congenital Anomalies) with additional diagnostic grouping of heart defects. Nationwide registers on medical redemptions (filled prescriptions), delivery, and hospital diagnosis provided information on mothers and newborns. Follow-up data available to December 2005.
Redemptions for SSRIs were not associated with major malformations overall but were associated with septal heart defects (odds ratio 1.99, 95% confidence interval 1.13 to 3.53). For individual SSRIs, the odds ratio for septal heart defects was 3.25 (1.21 to 8.75) for sertraline, 2.52 (1.04 to 6.10) for citalopram, and 1.34 (0.33 to 5.41) for fluoxetine. Redemptions for more than one type of SSRI were associated with septal heart defects (4.70, 1.74 to 12.7)). The absolute increase in the prevalence of malformations was low-for example, the prevalence of septal heart defects was 0.5% (2315/493 113) among unexposed children, 0.9% (12/1370) among children whose mothers were prescribed any SSRI, and 2.1% (4/193) among children whose mothers were prescribed more than one type of SSRI.
There is an increased prevalence of septal heart defects among children whose mothers were prescribed an SSRI in early pregnancy, particularly sertraline and citalopram. The largest association was found for children of women who redeemed prescriptions for more than one type of SSRI.

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Available from: Tine Brink Henriksen, Oct 05, 2015
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    • "Revue de la littérature paroxétine d'avoir un enfant avec une anomalie cardiaque est de presque 2 % alors que ce même risque dans la population générale est estimé à 1 %. Une autre étude [6] est arrivée aux mêmes conclusions avec la sertraline et le citalopram, et ce surtout en cas d'association de deux IRS. D'autres revues de la littérature et méta-analyses ont conclu que la fréquence des anomalies congénitales chez les enfants des femmes sous IRS pendant le premier trimestre de la grossesse est susceptible d'être augmentée de façon faible, voire pas du tout [7] [8] [9] [10] [11] [12]. "
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    ABSTRACT: Abstract in French and in English Résumé La grossesse et le postpartum sont des périodes particulières concernant l’utilisation de psychotropes chez la future mère. La prescription thérapeutique doit tenir compte du risque éventuel de malformation chez le fœtus, de syndrome de sevrage chez le nouveau-né, du type d’allaitement et du risque potentiel de la maladie mentale maternelle non traitée. Les recommandations de bonne pratique sont en perpétuel remaniement et leurs conclusions parfois contradictoires. Méthode : le but de ce travail est d’élaborer un référentiel actualisé à partir d’une revue de la littérature, facile d’utilisation pour tout professionnel concerné par le suivi ou la prescription d’un traitement psychotrope (antidépresseurs, anxiolytiques-hypnotiques, neuroleptiques, thymorégulateurs et traitements de substitution de la dépendance aux opiacés) chez une femme enceinte ou qui allaite. Résultats : ces mises au point, sous forme de tableaux, se basent également sur notre expérience clinique en tant qu’équipe spécialisée en médecine périnatale. Summary Pregnancy and the postpartum periods are particular for the mother's use of drugs. Therapeutic prescription must take into account the potential risk of fetal malformation, newborn's withdrawal syndrome, feeding type and potential risk of untreated maternal mental illness. Recommendations for good practice are constantly remodeling and their conclusions are sometimes contradictory. Method: The aim of this work is to develop an updated review, easy to use for any professional involved in the monitoring or prescription of a psychotropic medication (antidepressants, anxiolytics-hypnotics, neuroleptics, mood stabilizers and substitution treatment of opioid dependance) for pregnant or nursing women. Results: These updates in tabular form are also based on our clinical experience as a team specializing in perinatal medicine.
    La Presse Médicale 01/2015; 44(3):271-283. DOI:10.1016/j.lpm.2014.07.026 · 1.08 Impact Factor
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    • "Some depressive symptoms such as lack of appetite, pessimistic thoughts, and insufficient self-care can be especially hazardous during pregnancy, affecting both the mother and the fetus. The treatment of antenatal depression is challenging since some antidepressant drugs have been associated with birth defects, e.g., paroxetine (75), sertraline (75), citalopram (76), and fluoxetine (76). In addition, several antidepressant drugs are not recommended for postnatal depression - some examples include SSRIs, venlafaxine, and lithium (77). "
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    ABSTRACT: Patients with clinical diseases often present psychiatric conditions whose pharmacological treatment is hampered due to hazardous interactions with the clinical treatment and/or disease. This is particularly relevant for major depressive disorder, the most common psychiatric disorder in the general hospital. In this context, nonpharmacological interventions could be useful therapies; and, among those, noninvasive brain stimulation (NIBS) might be an interesting option. The main methods of NIBS are repetitive transcranial magnetic stimulation (rTMS), which was recently approved as a nonresearch treatment for some psychiatric conditions, and transcranial direct current stimulation (tDCS), a technique that is currently limited to research scenarios but has shown promising results. Therefore, our aim was to review the main medical conditions associated with high depression rates, the main obstacles for depression treatment, and whether these therapies could be a useful intervention for such conditions. We found that depression is an important and prevalent comorbidity in a variety of diseases such as epilepsy, stroke, Parkinson's disease, myocardial infarction, cancer, and in other conditions such as pregnancy and in patients without enteral access. We found that treatment of depression is often suboptimal within the above contexts and that rTMS and tDCS therapies have been insufficiently appraised. We discuss whether rTMS and tDCS could have a significant impact in treating depression that develops within a clinical context, considering its unique characteristics such as the absence of pharmacological interactions, the use of a nonenteral route, and as an augmentation therapy for antidepressants.
    Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 10/2013; 46(10):815-908. DOI:10.1590/1414-431X20133115 · 1.01 Impact Factor
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    • "This dataset reported an exposed sample size of 2631 (mean per sample 374±288) and control sample size of 497,307 (mean per sample 71,058±65,143). No unpublished data was collected and two papers (Wen et al., 2006; Pedersen et al., 2009) reporting SSRI exposure not differentiated by agent were included as independent samples. "
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    ABSTRACT: Context:It has been suggested that the commonly prescribed class of antidepressants selective serotonin reuptake inhibitors (SSRIs) are associated with birth defects. However, the teratogenic effect of individual SSRIs has not been previously compared using meta-analysis.Objective:To determine the strength of the association between individual SSRIs and major, minor, and cardiac malformation among infants born to women taking these medications.Data sources:Electronic search of CINAHL, EMBASE, Medline, PsycINFO, and ISI Web of Science using the search terms (SSRI OR antidepressant) AND (obstetric outcome OR malformation OR birth outcome OR teratogen), supplemented by manual searching of published references and requests of primary researchers for unpublished data.Study selection:There were 115 studies identified by electronic search and reviewed in full text, which yielded 16 papers reporting 36 data samples for major malformations, nine papers reporting 26 data samples for cardiac malformations, and four papers reporting seven data samples for minor malformations.Data synthesis:Fluoxetine (OR 1.14, 95% CI 1.01-1.30) and paroxetine (OR 1.29, 95% CI 1.11-1.49) were associated with increased risk of major malformations. Paroxetine was associated with increased risk of cardiac malformations (OR 1.44, 95% CI 1.12-1.86). Sertraline and citalopram were not significantly associated with congenital malformation. Between-sample heterogeneity was low and a range of methodological considerations had no significant impact on effect size. There was little evidence of publication bias.Conclusions:Fluoxetine and paroxetine should be avoided in the first trimester and among those at risk of an unplanned pregnancy.
    Australian and New Zealand Journal of Psychiatry 06/2013; 47(11). DOI:10.1177/0004867413492219 · 3.41 Impact Factor
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