Benefits of antidepressants during pregnancy outweigh risks
A case-control study has found no link between the duration of antidepressant therapy during pregnancy and the risk of major congenital abnormality.
The study identified 2,329 women who were pregnant between January 1998 and December 2002. All women had a recorded diagnosis of at least one major psychiatric disorder, had taken antidepressants for at least 30 days in the year before they became pregnant and had subsequently had a live birth or stillbirth. Around half the participants received welfare support.
Data on the drug(s) used and the duration of exposure were collected.
Paroxetine, sertraline and venlafaxine were the most commonly used antidepressants, although tricyclics and other drugs were also prescribed. The mean duration of therapy during the first trimester was 55 days.
Women were assigned to the case group if their infants had at least one major congenital abnormality (8.1% of the study population). The remaining women formed the control group. The most common anomaly was atrial septal defect (12.1% of cases). No link between the risk of major congenital abnormality and the class or type of antidepressant used, or duration of use, during the first trimester was found (OR 1.10, 95% CI 0.75-1.62).
Case-control studies have to be interpreted cautiously. The congenital abnormality rate of 8.1% is more than double what might have been expected in the general population. However, poorer socioeconomic status and psychiatric illness, both features of this cohort, are associated with adverse neonatal outcomes.
The lack of a link between the type of drug and duration of use in this higher-risk group is useful. The findings reassure me that initiation or maintenance of antidepressant therapy in pregnancy still appears safe relative to the dangers of withholding or stopping treatment.
Ramos E, St-André M, Rey É et al. Duration and antidepressant use during pregnancy and risk of major congenital malformations. Br J Psychiatry 2008;192:344-50Reviewer
Dr Chris Barclay