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Safety of psychotropic drugs in pregnancy

BMJ 2015; 350 doi: (Published 13 May 2015) Cite this as: BMJ 2015;350:h2260
  1. Hind Khalifeh, NIHR research fellow,
  2. Clare Dolman, service user researcher,
  3. Louise M Howard, NIHR research professor
  1. 1Section of Women’s Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  1. Correspondence to: L M Howard louise.howard{at}

Reassuring findings on antidepressants and antipsychotics from the largest studies to date

Mental illness in pregnancy is common—around 10% of women experience a major depressive illness or anxiety disorder,1 and an increasing number of women with psychotic disorders are able to conceive owing to the decreased use of antipsychotics with prolactin raising properties.2 Women who have severe mental illness in the perinatal period are at risk of considerable psychological morbidity, including suicide,2 but they often discontinue psychotropics,3 largely because of concerns about safety.4 Evidence on the risks of drugs from observational data is limited and contradictory, with important methodological limitations due to bias, confounding, and small sample sizes.5 In two linked papers in this issue, Furu and colleagues (doi:10.1136/bmj.h17986 and Vigod and colleagues (doi:10.1136/bmj.h2298)7 tackle some of these limitations by using novel methods to reduce confounding in large linked datasets, and thus provide a valuable addition to the evidence base on the safety of psychotropic drugs in pregnancy.

Furu and colleagues used national data from the five Nordic countries to examine the association between maternal use of selective serotonin reuptake inhibitors (SSRIs) or venlafaxine in the first trimester and birth defects among 2.3 million live singletons, including 36 772 (1.6%) exposed infants. To account for familial or unmeasured …

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