A report in British Medical Journal (via medpagetoday.com) caught my eye today.  It is a report on a Denmark cohort study (no experiments or interventions, just retrospectively reviewing the charts of a group of people and noting their characteristics) of “nearly half a million” Danish children showed that babies whose mothers received an SSRI while pregnant compared to those who did not receive SSRIs had a 1.99 times risk of septal heart defects (1.99 odds ratio, 95% CI 1.13 to 3.53).   For women taking multiple SSRIs during pregnancy, babies were at 4.70 times risk (95% CI 1.74 to 12.7).

Although the odds ratio would seem very alarming, the actual rate of babies getting septal heart defects remains low:  9 out of 1000 children born to mothers on one SSRI, or 21 children out of 1000 children born to mothers on multiple SSRIs would be expected to have heart defects.  In comparison, 4.5 out of 1000 children NOT on SSRIs get septal heart defects.

The take home for this study is this: the recent ACOG/APA recommendations on SSRIs in pregnancy remain applicable.  See more details on the recommendations on my previous blog post.  The addition to this is that generally women should NOT be on multiple SSRIs during pregnancy as that contributes a more significant risk as noted in the Denmark study.  However, women with severe depression stable on SSRIs should generally stay on their SSRIs during pregnancy as the overall risk of septal heart defect remains low on one SSRI (9 out of 1000 children on SSRI, versus 4.5 out of 1000 without SSRI).   In those with severe depression who are stable on SSRIs, the risk of relapse of depression with the discontinuation of SSRI, and the subsequent effect on the mother and child (mothers may eat poorly, miss prenatal visits, not follow medical instructions, use substances like tobacco, alcohol, recreational drugs to cope with depression, have difficulty meeting needs of child once she is born, and many more – see more details at womenshealth.gov) is significant and generally outweighs the risk of septal heart defect.  Of note, each individual case needs to be assessed by a psychiatrist and OB/Gyne to weigh the risks in the individual case.

Article written 9/29/09 by Minyang Mao, M.D.

Disclaimer: This article is intended as an educational resource only, and is not intended to be a replacement for treatment. For evaluation and treatment, please contact a qualified mental health professional.

Content © 2009 Minyang Mao, M.D.  Image © 2009 Bob Lin.  All rights reserved.