Use of SSRIs during pregnancy

Depression is common in pregnancy, affecting up to 20% of women, with about 13% taking an antidepressant during pregnancy. A new study from Denmark suggests that use of sertraline (Zoloft®) and citalopram (Celexa®) by mothers during pregnancy is associated with an increased risk of septal heart defects in their children. Researchers utilized the Danish nationwide registry to review nearly 500,000 births from 1996 to 2003. Selective serotonin reuptake inhibitors (SSRIs) in general were not associated with major malformations, but were associated with septal heart defects. Among the individual drugs, sertraline conveyed the highest risk (odds ratio [OR], 3.25; confidence interval [CI], 1.21-8.75), followed by citalopram (OR, 2.52; CI, 1.04-6.10). Use of more than one SSRI was associated with an OR of 4.70 (CI, 1.74-12.7). The absolute prevalence of septal heart defects was 0.5% among unexposed children, 0.9% among children whose mothers received any SSRI, and 2.1% among children whose mother were prescribed more than one SSRI (BMJ 2009:339:b3569; Epub ahead of print 23 Sept 2009). Significant in this study was the low overall rate of heart defects and the lack of association of heart defects with paroxetine (Paxil®) or fluoxetine (Prozac®), although the authors consider this a "class effect," and the greatest risk was noted if more than one drug was used during pregnancy.