Major depressive disorder in women is most common during their childbearing years, and about 13% of women in the United States have taken an antidepressant drug during pregnancy.1 2 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.3

In the linked population based cohort study from Denmark (doi:10.1136/bmj.b3569), 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 …