PSI Response- British Medical Journal Review published May 2015
The British Medical Journal has published a new study (BMJ 2015; 350:h3190) evaluating the potential risk of use of several Selective Serotonin Reuptake Inhibitors (SSRIs) from one month prior to conception through the first trimester. This study’s goal was to explore previously found associations between use of SSRIs and malformations, using data from previously published analyses with data from a new, 10-center population based, case-controlled study.
The investigators used phone-based interviews to assess use of SSRIs (citalopram, escitalopram, fluoxetine, paroxetine, and sertraline) during early pregnancy in the study population.
“The study controlled for several important possible confounders, including obesity, smoking and race/ethnicity. It did not, however, control for severity of illness. The results were overall highly reassuring,” said Carly Snyder, M.D., a Psychiatrist in New York City with a focus and expertise in Reproductive Psychiatry. Snyder is also Research Chair of Postpartum Support International (PSI).
Sertraline was the most commonly used SSRI in the study; contrary to prior reports, it was not associated with any malformations. Citalopram and escitalopram were similarly not found to be associated with any specific malformations.
Use of fluoxetine or paroxetine was found to be associated with higher risks of several birth defects, specifically related to cardiac and brain formation. However, these risks must be taken in context, as the absolute risk remained extremely low. The highest odds ratios was for use of paroxetine and risk of anencephaly (2/10,000 – 7/10,000) and right ventricular outflow defects (10/10,000 – 24/10,000).
It is important to note that the increased risk still remained below the 5% risk of malformations that is present for all pregnancies, unrelated to any specific exposure to medication. Because these specific types of birth defects are rare, even doubling the risk still results in a low absolute risk.
“Based on this exhaustive, well-executed study, use of an SSRI in early pregnancy does not increase the risk of any specific major malformation above the baseline population risk. This is highly reassuring and is further evidence that it is important that women address their mental health needs before, during and after pregnancy,” added Snyder.
Postpartum Support International is the leading organization dedicated to helping women suffering from perinatal mood disorders. Visit the PSI website postpartum.net to locate all types of resources for new moms including counseling, support groups, and other tools for moms and dads.