Antidepressants and impact on birth defects
Results of a new Canadian study published in the British Journal of Medicine suggest that using certain types of antidepressants during pregnancy may increase risk of birth defects.
Researchers used data from the Quebec Pregnancy Cohort and included all pregnancies that had a diagnosis of depression or anxiety or an exposure to antidepressants in the 12 months prior to the pregnancy and resulted in a live-born singleton. They compared individual use of various antibiotic types and classes including selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) with non-exposure during the first trimester. Any organ-specific malformation in addition to overall major congenital malformations found in the first year of life were identified.
The cohort consisted of 18,487 women. With specific types of antidepressant, only citalopram increased the risk of major congenital malformations (adjusted OR, [aOR] 1.36, 95% confidence interval [CI] 1.08 to 1.73; 88 exposed cases), but an increased risk trend was seen for the most frequently used antidepressants. Drugs with a serotonin reuptake inhibition effect (SNRIs, SSRIs, and the most used TCA amitriptyline) were found to increase the risk of some organ-specific malformations. Paroxetine was found to the increase the risk of ventricular/atrial septal defects (aOR 1.92, 95% CI 1.40 to 2.62) and the risk of cardiac defects (aOR 1.45, 95% CI 1.12 to 1.88). Tricyclic antidepressants were linked to digestive defects (aOR 2.55, 95% CI 1.40 to 4.66) and eye, ear, face, and neck defects (aOR 2.45, 95% CI 1.05 to 5.72). Venlaflaxine was tied to respiratory defects (aOR 2.17, 95% CI 1.07 to 4.38). Citalopram saw an increased risk of craniosynostosis (aOR 3.95, 95% CI 2.08 to 7.52) and musculoskeletal defects (aOR 1.92, 95% CI 1.40 to 2.62).
The investigators concluded that antidepressants that affected serotonin reuptake consumed during embryogenesis increased the risk of certain organ-specific malformations in pregnant women with depression.