APA: SSRIs in Pregnancy Not Associated With Cardiac or Pulmonary Problems

SAN DIEGO, May 23 -- In utero exposure to selective serotonin reuptake inhibitors was not significantly associated with the risk for cardiac malformations or persistent pulmonary hypertension.

In a retrospective review of records of more than 25,000 pregnant women treated at the Mayo Clinic in Rochester, Minn., from 1993 through 2005, there was no association between the mothers' SSRI use during pregnancy and the occurrence of congenital heart disease, ventricular septal defects, or persistent pulmonary hypertension in their children, reported Christina L. Wichman, D.O., and colleagues at the American Psychiatric Association meeting here.

"Recent data indicates that approximately 10% to 15% of women will have depression at any point during pregnancy or the post-partum period," they wrote. Selective serotonin reuptake inhibitors are the first line pharmacotherapy to treat depression, they noted, but "inconsistent data has been reported regarding the safety of SSRIs in pregnancy."

In a separate presentation, the same authors noted that the percentage of pregnant women in their practice who used SSRIs rose from less than 1% in 1993 to 5% in 2005. They speculated that the increase is because of an increasing perception among patients and physicians that the drugs are safe to use during pregnancy.

Although many studies have found no association between SSRIs in pregnancy and the risk for major birth defects above a baseline of 1% to 3%, several recent studies have suggested that paroxetine (Paxil) use in the first trimester may be associated with ventricular septal defects, and that newborns with late-pregnancy exposure to SSRIs are at increased risk for persistent pulmonary hypertension, the authors noted.

To see if they could find evidence of an association, the authors conducted a retrospective chart review of all pregnant women presenting at the Mayo Clinic from 1993 through 2005.

They identified a total of 25,214 deliveries during that period, and 745 mothers who had been treated with SSRIs during their pregnancies. The authors also reviewed the medical charts of the babies exposed to SSRIs during pregnancy to review fetal outcomes.

They found that among the 208 infants with congenital heart disease, only two had been exposed to SSRIs, and that there was no statistical association with SSRI use and congenital heart disease.

In all, 153 of the women had taken paroxetine during pregnancy, and none of their children were born with a ventricular septal defect. In addition, among 16 infants diagnosed with persistent pulmonary hypertension, none had been exposed to SSRIs in utero.

"Our data supports the safety of SSRIs during pregnancy in regards to cardiac malformations, including ventricular septal defects, and persistent pulmonary hypertension," the authors wrote.

They noted that their study was limited by the retrospective design, reliance on medical records rather than patient interviews, and the difficulty in diagnosing malformations such as ventricular septal defects in infancy.

The researchers recommended that women who are considering SSRI use during pregnancy be given informed consent with the discussion focusing on the risks of depression in pregnancy, non-drug treatment options, possible risks of SSRI exposure to the fetus, potential adverse effects on the mother, and the benefits of SSRI use in treatment of depression.