By Jane Collingwood
Researchers looking into the safety of antidepressants during pregnancy have found that there may be a small risk of heart defects in the unborn child.
The risk applies only to mothers who take selective serotonin reuptake inhibitors in early pregnancy, say Dr Lars Henning Pedersen of Aarhus University, Denmark, and colleagues.
On the website of the British Medical Journal they report on their study of 493,113 children born in Denmark between 1996 and 2003. Prescriptions for selective serotonin reuptake inhibitors "were not associated with major malformations overall", but were linked with defects in the muscle wall that divides the heart chambers.
The risk was highest for sertraline and lowest for fluoxetine. It was higher still for women taking more than one type of selective serotonin reuptake inhibitor.
"The absolute increase in the prevalence of malformations was low," say the authors. The rate was 0.5 per cent among unexposed children, 0.9 per cent with any selective serotonin reuptake inhibitor, and 2.1 per cent with more than one type.
One child in every 246 children exposed to any of these medications is likely to suffer a heart defect, they calculate.
In an editorial, Dr Christina Chambers of the University of California San Diego, USA, writes: "The small risk of harm must be balanced against risk of suboptimal or no treatment."
She explains that, over the past 20 years, selective serotonin reuptake inhibitors have become an important treatment for women with major depression. "Concerns persist about safety for the developing foetus," she writes, but "this is counterbalanced by equally compelling concerns about the consequences of undertreatment for mother and child."
Chambers, C. Selective serotonin reuptake inhibitors and congenital malformations. The British Medical Journal, 2009;339:b3525.
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