Selectiwe serotonin reuptake inhibitors and congenital malformations The small risk of harm must be balanced against risk of suboptimal or no treatment

摘要

Major depressive disorder in women is most common during their childbearing years, and about 13% of women in the United States have taken an ana'depres-sant drug during pregnancy.In the past 20 years, selective serotonin reuptake inhibitors (SSRIs) have become a mainstay of treatment in women with major depressive disorder; however, concerns persist about safety for the developing fetus. This is counterbalanced by equally compelling concerns about the consequences of undertreatment for mother and child.In the linked population based cohort study from Denmark, Pedersen and colleagues confirm a previously reported doubling of risk for septal heart defects after early exposure in pregnancy to SSRIs (odds ratio 1.99, 95% confidence interval 1.12 to 3.53).4 However, in contrast to previous studies, redemptions of prescriptions for citalopram and sertraline, but not paroxetine or fluoxetine, were significantly associated with this group of heart defects.Furthermore, unlike two previous large case-control studies conducted in the US, no association was noted with anencephaly, omphalocele, craniosynostosis, or right ventricular outflow tract defects.