Are selective serotonin reuptake inhibitors cardiac teratogens? Echocardiographic screening of newborns with persistent heart murmur

Abstract

Newborns exposed in utero to SSRIs, have a twofold higher risk of mild nonsyndromic heart defects than unexposed infants. The data suggest that women who require SSRI treatment during pregnancy can be reassured that the fetal risk is low and possible cardiac malformations will probably be mild. Late-targeted ultrasound and fetal echocardiography at 22 to 23 weeks' gestation are recommended in this patient group.

First‐trimester use of paroxetine and congenital heart defects: A population‐based case‐control study

“…In 2005, the manufacturer of paroxetine, a frequently used SSRI, issued a warning that preliminary analyses from safety data showed an increased risk of cardiovascular anomalies after use of paroxetine compared with use of other antidepressants (GlaxoSmithKline Clinical Trial Register, 2005). After this warning, several cohort studies were published on this association, but the results are inconclusive (Cole et al, 2007;Kallen and Otterblad 2007;Diav-Citrin et al, 2008;Merlob et al, 2009;Pedersen et al, 2009). Together, these cohort studies indicate that SSRIs do not have a major teratogenic effect.…”

Fetal Effects of Selective Serotonin Reuptake Inhibitor Treatment During Pregnancy: Immediate and Longer Term Child Outcomes

“…A significant association with cardiac defects was reported in six studies 62,64,65,67,69 in comparison to four others which investigated but failed to find an association with cardiac defects 31,58,59,63 . Dubnov-Raz and colleagues 70 reported an association between longer QTc intervals across SSRI types (n = 52).…”

“…Once the earlier publications from the Swedish and Finnish Birth Registries are removed from consideration, five cohort studies failed to report an association 36,38,44,67,71 which was consistent with the negative findings from the case control studies by Pedersen et al and Alwan et al 58,65 . A significant relationship between fluoxetine exposure and specific malformations has been reported in four studies 58,63,69,72 , three of which reported a significant association with cardiac defects 63,69,72 , with the fourth, a case control study, reporting an increased risk of craniosynostosis 58 . These results are in conflict with the results of four other studies which examined specific malformation types following prenatal exposure to fluoxetine but failed to find a significant effect 56,62,65,67 .…”

“…Significant associations were reported between SSRI exposure and specific malformation types in seven cohorts 58,60,62,64,65,67,69 . A significant association with cardiac defects was reported in six studies 62,64,65,67,69 in comparison to four others which investigated but failed to find an association with cardiac defects 31,58,59,63 .…”

“…Seven cohorts demonstrated a significant association between paroxetine exposure and cardiac defects 56,62,63,69,74,75 including the Berard et al 74 study that demonstrated an effect of dose. Six studies investigated but did not find an association between paroxetine exposure and cardiac defects 44,58,59,65,67,73,76 .…”