Published 21 October 2009, doi:10.1136/bmj.b4292
Cite this as: BMJ 2009;339:b4292

Letters

SSRIs and congenital defects

Women should give informed consent before starting SSRIs

The first 150 words of the full text of this article appear below.

In Pedersen and colleagues’ study of selective serotonin reuptake inhibitors (SSRIs) in pregnancy, the hazards were clearest for citalopram and sertraline.¹ However, a meta-analysis of all epidemiologically robust studies of paroxetine in the first trimester of pregnancy conclusively shows increased prevalence of both cardiac malformations (odds ratio 1.46, 95% confidence interval 1.17 to 1.82) and total malformations (1.24, 1.08 to 1.43).²

One of the best signals of teratogenicity is an increased rate of spontaneous abortions and a key reason for induced abortion is congenital malformations.¹ Data on SSRIs in 1998 showed that the rate of abortion (spontaneous and induced) was nearly twice as high in those who had taken SSRIs in the first trimester of pregnancy (1.7, 1.1 to 2.9).³

Given the limited evidence for effectiveness and these data on potential hazards for the unborn child, the risk-benefit equation is not favourable for SSRIs in pregnancy. The numbers affected are . . . [Full text of this article]

¹ Primary Care Research Unit, Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand

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