Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy

Robert Davis, David Rubanowice, Heather McPhillips, Marsha A. Raebel, Susan E. Andrade, David Smith, Marianne Ulcickas Yood, Richard Platt

Research output: Contribution to journalReview article

146 Citations (Scopus)

Abstract

Purpose: To evaluate risks for perinatal complications and congenital defects among infants exposed in utero to antidepressants. Methods: We identified 2201 women who were prescribed an antidepressant during pregnancy and who delivered an infant within one of five large managed care organizations (HMO). Prescription drug dispensings and inpatient and outpatient diagnoses were obtained from automated databases at each HMO. Antidepressants were categorized into tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), and medication timing was assessed by trimester. Rates of congenital anomalies or perinatal complications were compared to infants whose mothers were not prescribed antidepressants during pregnancy. Results: Infants exposed to SSRIs or TCAs during pregnancy had a significant increase in preterm delivery risk. Fullterm infants exposed to SSRIs during the third trimester had an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, hypoglycemia, temperature regulation disorders, and convulsions. Third-trimester exposure to TCAs was also associated with an increased risk for respiratory distress syndrome, endocrine and metabolic disturbances, and temperature regulation disorders. There were 182 infants exposed to Paroxetine, and these infants did not have an increased risk of cardiac septal defects. Conclusions: SSRIs and TCAs did not show a consistent link with congenital anomalies. Paroxetine exposure was not linked with an increased risk for cardiovascular anomalies, although our study power to detect a moderate increase in risk was limited. Infants exposed to antidepressants were at increased risk for preterm delivery. Both SSRIs and TCAs used during the third trimester appeared to increase the risk for perinatal complications and their use should be managed carefully among pregnant women with depression.

Original languageEnglish (US)
Pages (from-to)1086-1094
Number of pages9
JournalPharmacoepidemiology and Drug Safety
Volume16
Issue number10
DOIs
StatePublished - Oct 1 2007
Externally publishedYes

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Antidepressive Agents
Tricyclic Antidepressive Agents
Pregnancy
Serotonin Uptake Inhibitors
Third Pregnancy Trimester
Paroxetine
Health Maintenance Organizations
Heart Septal Defects
Temperature
Prescription Drugs
Managed Care Programs
Hypoglycemia
Inpatients
Pregnant Women
Seizures
Outpatients
Mothers
Organizations
Databases
Depression

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Pharmacology (medical)

Cite this

Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy. / Davis, Robert; Rubanowice, David; McPhillips, Heather; Raebel, Marsha A.; Andrade, Susan E.; Smith, David; Yood, Marianne Ulcickas; Platt, Richard.

In: Pharmacoepidemiology and Drug Safety, Vol. 16, No. 10, 01.10.2007, p. 1086-1094.

Research output: Contribution to journalReview article

Davis, Robert ; Rubanowice, David ; McPhillips, Heather ; Raebel, Marsha A. ; Andrade, Susan E. ; Smith, David ; Yood, Marianne Ulcickas ; Platt, Richard. / Risks of congenital malformations and perinatal events among infants exposed to antidepressant medications during pregnancy. In: Pharmacoepidemiology and Drug Safety. 2007 ; Vol. 16, No. 10. pp. 1086-1094.
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