No malformation risk of SSRIs in pregnancy

NICE guidelines on use of antidepressants in pregnancy could be changed following US study findings showing SSRI use in pregnancy poses a low risk of birth malformations.

No malformation risk of SSRIs in pregnancy
No malformation risk of SSRIs in pregnancy

Information to date on the safety of SSRIs in pregnancy has been sparse.

But two retrospective studies have concluded there is no evidence SSRI use in pregnancy is associated with a significantly increased risk of birth malformations. This included congenital heart defects, craniosynostosis and omphalocele.

The risk of having an affected child would be less than 1 per cent, the researchers reported.

NICE guidelines on antenatal and postnatal mental health (APMH) issued in February favoured psychotherapies for treatment of depression in pregnant women.

When pharmacotherapy is needed, NICE considered tricyclic antidepressants (TCAs) to have better safety profiles in pregnancy than SSRIs.

Chairman of the guideline development group and North Shields GP Dr Dave Tomson said: ‘I'm interested in this research and it will certainly have to be part of a review NICE does of the antenatal and postnatal mental health guideline.

'We know most about TCAs because they've been around for longer, and it was on that basis that we were able to say that evidence suggests TCAs could be safe in pregnancy. We didn't know that about SSRIs.

'It may be that over time we become confident SSRIs are safe.'

N Eng J Med 2007; 356: 2,675-2,683; 2,684-2,692

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