First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects

In this large case–control study, the first-trimester use of selective serotonin-reuptake inhibitors (SSRIs) overall was not associated with significantly increased risks of craniosynostosis, omphalocele, or heart defects. Analyses of individual SSRIs revealed some significant associations; however, the analyses involved multiple comparisons and small numbers of exposed subjects. These findings do not show significantly increased risks of major birth defects in association with SSRI use overall. The first-trimester use of selective serotonin-reuptake inhibitors overall was not associated with significantly increased risks of craniosynostosis, omphalocele, or heart defects. Symptoms of clinical depression affect 8 to 20% of women 1 , 2 ; during pregnancy, about 10% of women are affected, 3 and many of these women are treated with antidepressants. In the late 1980s, a new class of antidepressants, selective serotonin-reuptake inhibitors (SSRIs), appeared and rapidly gained widespread acceptance because they have fewer side effects than the older tricyclic antidepressants and pose less risk when taken in overdose. 4 However, concern has been raised about their potential effects on the fetus. Neonatal effects, known as “SSRI neonatal withdrawal syndrome” or “SSRI abstinence syndrome,” 5 – 9 are now well established, but the relation of . . .