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Rapid response to:


Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study

BMJ 2009; 339 doi: (Published 23 September 2009) Cite this as: BMJ 2009;339:b3569

Rapid Response:

It's all in the presentation-SSRI's pregnancy outcomes

After reading the latest study regarding the safety of SSRI's in
pregnancy and
concuring with Dr Chambers editorial, and as we are familiar with the
limitations of these types of studies, we are not going to criticize the
methodology or the results per se. What was interesting to us was how the
results were presented,especially in the abstract.

At The Motherisk Program, a Teratogenic counseling service at The Hospital

for Sick Children, in Toronto, Canada, we answer calls from more than
women and their health care providers every year about the safety of drugs
pregnancy and have published hundreds of papers in this field, including
many on the safety of antidepressants in pregnancy(

Most pregnant women call us because they were advised by their physician,
who often have only read the abstract of papers, and do not know how to
advise their patients. Because of this, it should behoove us to ensure
important data is included and it was not in this abstract, most notably
in the
conclusion which was quite misleading. The authors stated that there was
increased risk for septal defects "particularly" with sertraline and
citalopram,as if there was also with other SSRI's, which there were not,
and it
should have said "only sertraline and citalopram." In addition, they
have stated that there was no association with paroxetine, which is very
important new data, as there have been many warnings about paroxetine and
heart defects and not other antidepressants. Women with depression and
their health care providers,deserve information that is unambiguous
containing all the important evidence-based information, even if it is in
250 words.

Thank you

Competing interests:
None declared

Competing interests: No competing interests

30 September 2009
Adrienne Einarson
Assistant Director, The Motherisk Program.
Pina Bozzo
The Hospital for Sick Children, Toronto, Ontario. Canada, M5G 1X8