Pregnant women who take a specific type of
antidepressant in early pregnancy have a small but significantly greater
risk of having babies with major congenital anomalies (sometimes
referred to as birth defects) or stillbirths compared with those who did
not take these antidepressants, revealed a dose-response
analysisá carried out at Swansea University.
Professor Sue Jordan, of the College of Human and Health Sciences
led the international research team1 of academics from the UK, Denmark
and Norway. The study published in the PLOS ONE
journal, analyzed data from more than 500,000 infants in Wales, Norway
‘Pregnant women who take selective serotonin reuptake inhibitors (SSRIs) in early pregnancy have a small but significantly greater risk of having babies with major congenital anomalies.’
The findings suggest that women who had been prescribed selective
serotonin reuptake inhibitors, known as SSRIs, in the first trimester of
pregnancy or three months before pregnancy were at a small but
significantly greater risk of having infants with congenital anomalies,
particularly severe heart defects or stillbirths compared with those who
did not take SSRIs.
The study found that where SSRIs were not prescribed, six in 200
pregnancies had an adverse outcome of stillbirth or a baby with a major
congenital anomaly, but when SSRIs were prescribed this rose to seven in
200. The team say this risk is of public health importance due to the
severity of the outcome and because SSRIs are prescribed to 5.5% of
pregnant women in Wales, 2.1% in Denmark and 1.6% in Norway.
Now, the researchers are calling on health care professionals to take the following action:-
- review all women requesting SSRI prescriptions and not just those who are planning pregnancy.
- consider women who misuse substances or alcohol as being at higher risk of adverse pregnancy outcomes when prescribed SSRIs
- evaluate pre-pregnancy care when SSRIs are prescribed
- consider offering at-risk women enhanced scans to detect serious heart defects
- ensure that appropriate levels of neonatal care are available to at-risk women at birth
Professor Jordan said, "To our knowledge, this is the first
dose-response analysis that shows the link between SSRI doses and
congenital anomalies and stillbirths. While this extra risk may seem
small, in my view, the outcomes are as serious as they can be."
"Women should not stop taking SSRIs without consulting their
doctors, and we are not saying stop all medicines, but our message is
that we want our health care professionals to be very mindful of this
link and to take the appropriate action to ensure that women are given
the right type of care before, during and after pregnancy to minimize
the risks of congenital anomalies and stillbirths linked to SSRIs."
Professor Helen Dolk, who led the EUROmediCAT project, said, "Women
should not stop taking SSRIs without discussing with their doctor the
benefits and risks of SSRIs and alternative nonpharmacological
therapies, since good mental health is important for both mother and