Letter to the Editor
Antidepressant drugs during pregnancy and infant congenital heart defect

https://doi.org/10.1016/j.reprotox.2005.11.006Get rights and content

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    Current literature, which includes several large cohort studies and metaanalyses, concluded that SSRIs as a group are not associated with an elevated risk of congenital malformations.58,75,76,103-106 There is some evidence that individual SSRIs may be associated with very low risk of minor malformations that include the cardiovascular defects that are associated with first-trimester paroxetine exposure that prompted a 2005 Food and Drug Administration/GlaxoSmithKline warning to healthcare providers.58,75,76,90,103,105-108 More recently, independently conducted meta-analyses demonstrate slightly increased prevalence of cardiac defects with first trimester paroxetine exposure; however, absolute risks are quite low.104,109,110

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    These medications are generally considered safe, with limited incidence of SSRI-related birth abnormalities and pregnancy complications (Grigoriadis et al., 2013; Ross et al., 2013; Vasilakis-Scaramozza et al., 2013). In 2005, the Food and Drug Administration (FDA) issued a warning against using the SSRI paroxetine during pregnancy due to reports of fetal cardiovascular malformation (Kallen and Otterblad Olausson, 2006; Bar-Oz et al., 2007). Similar concerns were raised for other SSRIs, including fluoxetine (Diav-Citrin et al., 2008; Jimenez-Solem et al., 2012), citalopram (Pedersen et al., 2009; Jimenez-Solem et al., 2012) and sertraline (Louik et al., 2007; Pedersen et al., 2009; Kornum et al., 2010; Jimenez-Solem et al., 2012), although subsequent studies concluded that the effects were small and that SSRIs generally pose minimal teratogenic risks (Malm et al., 2005; Wogelius et al., 2006; Alwan et al., 2007; Berard et al., 2007; Cole et al., 2007; Louik et al., 2007; Diav-Citrin et al., 2008; Einarson et al., 2008; Oberlander et al., 2008c; Pedersen et al., 2009; Bakker et al., 2010; Kornum et al., 2010).

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