A recent longitudinal study confirms a causal link between SSRIs and congenital heart defects(1). This is not altogether new data, however, does emphasize the importance of education and screening of pregnant women for depression, and antidepressant use. Current estimates of lifetime prevalence of depression is 17 percent, and up to 8 percent of pregnant women are thought to be on an antidepressant medication during pregnancy(2).
Antidepressants cross the placenta and the fetal blood-brain barrier. This makes the risk for potential teratogenic effects, including congenital heart defects more likely in this population. The risks for preterm birth, low birth weight, and pregnancy complications also increases. Postnatal effects such as persistent pulmonary hypertension have also been linked to SSRI use during pregnancy(3).
The current research study looked at almost 520,000 deliveries, including 462,641 cases followed one year to either side of pregnancy(1). SSRI exposure was assessed 91 days either side of the last menstrual period. Pausing or discontinuation of SSIs preconception, confounding, high dose regimens and actual diagnosis of depression were also explored. Results combined in meta-analysis revealed a definite increase in congenital heart defects. These results seem to be dose dependent, with a higher prevalence in pregnant women who had multiple prescriptions within the 91-day pre-term period. There was no significant increase in other major anomalies. These causal relationships were unchanged when adjusted for socio-economic status.
The absolute risk of teratogenesis associated with SSRIs, was concluded to be fairly small, but significant. Because of the prevalence of SSRI usage, and depression, this does seem to be a matter of consideration, and pregnant women should be screened and educated.
- Jordan S, et al. Selective Serotonin Reuptake Inhibitor (SSRI) Antidepressants in Pregnancy and Congenital Anomalies: Analysis of Linked Databases in Wales, Norway and Funen, Denmark. PLoS One. 2016 Dec 1;11(12):e0165122. doi: 10.1371/journal.pone.0165122. eCollection 2016.
- Huybrechts KF. et al. National trends in antidepressant medication treatment among publicly insured pregnant women. Gen Hosp Psychiatry. 2013 May;35(3):265-71. Epub 2013 Jan 30.
- Bérard A, et al. SSRI and SNRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn. Br J Clin Pharmacol. 2016 Nov 22. doi: 10.1111/bcp.13194.
Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.
