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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:

Most induced abortions not for malformations, and absolute safety of SSRI for majority of users

Professor Mangin notes "a key reason for induced abortion is
congenital malformations", but this in the UK at least is a very small
fraction of all terminations performed. Far commoner is that the pregnancy
is not desired, and I would suggest that those women who are depressed are
less likely to wish to face the burden of pregnancy and a child. One can
argue that the likelihood of not being able to continue with SSRI during
pregnancy, or of women being poorly treated on low-doses of SSRIs might
affect the numbers choosing for terminations.

Whilst an abnormality is a disaster for the individuals concerned, we
risk losing sight of the absolute numbers who do NOT get septal heart
defects - 99.5% in those unexposed, 99.1% children of women with one or
more redemption of SSRI and in the case of fluoxetine (0.6% prevalence) a
99.4% chance of no effect. Whilst I think many women will choose to stop
SSRI and see how things fare, at least for the first trimester, we should
be careful not to imply they are always dangerous and can never be taken
at all in pregnancy; the paper concludes number needed to harm for SSRIs
overall is 246, but for fluoxetine this seems more like 1000.

Competing interests:
None declared

Competing interests: No competing interests

01 October 2009
David H Ruben
Salaried GP
Mill Hill, London NW7 1GR