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Teratogenicity of SSRI Antidepressants
Alwan S, Reefhuis J. Rasmussen S, Olney R, et al
Posted: September 2007  
NEJM   2007;356:2684-2692

Another case-control study also found no association between SSRI antidepressant use in early pregnancy and most birth defects. However, the study did find some associations that have not been previously reported. The lack of a consistent pattern in this and other studies suggests SSRIs are not major teratogens.

Methods:   Affected infants were identified from a population-based database of birth defects in 8 states. Infants with congenital anomalies who died at 20 or more weeks of gestation and aborted fetuses with reliably ascertained defects were included, but those with chromosomal or single-gene defects were not. Birth defects present in more than 200 cases were included in the analysis. Mothers were interviewed between 6 weeks and 2 years after delivery about whether they had taken SSRIs from 1 month before to 3 months after conception.

Results:   SSRI use before or during the first trimester was reported by 2.3% of case and control mothers. On average, mothers of case patients were older than controls, had lower levels of education and income, and were more likely to be obese, to smoke, and to have hypertension and diabetes.

SSRI use was found to be associated with anecephaly, craniosynostosis, and omphalocele. None of the individual SSRIs were associated with overall risk of birth defects or with the combined totals of cardiac or noncardiac defects. Paroxetine and citalopram were each associated with the combined group of anecephaly, craniosynostosis, and omphalocele.