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Risk for congenital heart anomalies unaffected by maternal SSRI use

Recent findings indicated no increased risk for congenital heart anomalies among children of women prescribed selective serotonin reuptake inhibitors during pregnancy; however, diabetes, older age, alcohol and drug abuse and obesity increased risk.

“The biological mechanism for congenital cardiac anomalies in a fetus exposed to [selective serotonin reuptake inhibitors (SSRIs)] is not well understood. In addition to acting as a neurotransmitter involved in signaling between neurons, serotonin also acts as a signaling molecule during embryogenesis affecting cell proliferation, migration, death and differentiation. Thus, serotonin may be influencing heart development as it may act as an important signaling neurotransmitter,” Irene Petersen, PhD, of University College London, and colleagues wrote.

Researchers used data from The Health Improvement Network primary care database in the United Kingdom from 1990 through 2011 to conduct a comparative study examining associations between SSRIs prescribed in pregnancy and congenital heart anomalies and associations between social, lifestyle characteristics of pregnant women and congenital heart anomalies. Study participants included children of women receiving SSRIs before pregnancy (n = 5,154), receiving SSRIs during pregnancy (n = 2,776), receiving other antidepressants during pregnancy (n = 992) and not receiving any antidepressants before or during pregnancy (n = 200,213).

Less than 1% of children had record of congenital heart anomalies within 5 years of birth.

Researchers found no significant differences related to antidepressant exposure in pregnancy; women prescribed SSRIs in the first trimester had an odds ratio of 1 (95% CI, 0.65-1.52) for congenital heart anomalies compared with women not prescribed antidepressants.

However, diabetes (OR = 2.23; 95% CI, 1.79-2.77), increasing age (OR = 1.01; 95% CI, 1-1.02), alcohol problems (OR = 2.58; 95% CI, 1.55-4.29), illicit drug problems (OR = 1.89; 955 CI, 1.09-3.25) and obesity (OR = 1.38; 95% CI, 1.13-1.69) were associated with increased risk for having a child with congenital heart anomalies, independent of antidepressant prescription.

“Women often receive conflicting messages on whether they should continue taking antidepressants during pregnancy and many women may discontinue antidepressants in pregnancy because they fear adverse effects on their unborn child,” Petersen said in a press release. “Our research adds to the ongoing debate on whether these drugs cause congenital heart anomalies, and we have found no evidence to any such effect. However, health care professionals should counsel women on other risks contributing to congenital heart anomalies in children such as age, weight, diabetes, alcohol problems and illicit drug use.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.