Antidepressants in First Trimester Not Linked to Heart Defects in Baby


Good news: Use of antidepressants in early pregnancy is not to blame for fetal cardiac malformations, should one occur.

The conversation about the safety of taking antidepressants during pregnancy continues as new research suggests there is no link between a mother’s intake during the first trimester and cardiac malformations in her unborn child. 

Pertinent Points

- Women who used antidepressants during their first trimester of pregnancy did not place their unborn infants at an increased risk of cardiac defects, a study concluded.

- The authors continued with the common recommendation that clinicians balance the risk of antidepressant use during pregnancy with the risk of not treating severe depression.

A review of pregnant Medicaid patients who took antidepressants found no significant increase in the risk of cardiac malformations among infants. The women all took antidepressants during the first trimester, and their babies were compared with infants born to women who did not have exposure to the drugs. The study looked at pregnancies from 2000 through 2007 and included 949,504 Medicaid recipients.

Specifically, and contrary to earlier findings, the researchers found no increased risks of cardiac defects and the use of paroxetine and sertraline.

Among the other antidepressants included were any SSRI, fluoxetine, tricyclic antidepressants, serotonin–norepinephrine reuptake inhibitors (SNRIs), and bupropion.

Of the women included in the review, 6.8% used antidepressants during the first trimester. Cardiac defects were found in 72.3 infants per 10,000 among those women who did not take antidepressants. Among women who did take the drugs, 90.1 per 10,000 infants had a cardiac defect. The difference was not a substantial one, the researchers concluded.

Furthermore, when the researchers adjusted the analysis to restrict the cohort only to women with a recorded diagnosis of depression, they found the link between antidepressant use and cardiac defects was weakened.

“In contrast to analyses in earlier studies, our adjusted analyses restricted the cohort to women with a recorded diagnosis of depression in order to mitigate potential confounding by the underlying psychiatric illness and associated conditions and behaviors, factors that might increase the risk of structural cardiac malformations by means of several mechanisms,” the authors wrote in the New England Journal of Medicine. “Smoking, alcohol and drug use, poor maternal diet, obesity, and chronic conditions such as diabetes and hypertension are all more common in patients with depression than in those without depression and are potential risk factors for congenital cardiac anomalies.”

Similar to the recommendations made in other studies, the authors of this study suggested that in making the decisions to continue the use of antidepressants during pregnancy that clinicians and women must balance the risks of treatments with the risks of not treating severe depression.

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