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SSRIs and Birth Defects

Burt, Vivien; Miller, Laura; Einarson, Adrienne

doi: 10.1097/01.ede.0000259343.32599.a2
LETTERS: Letters to the Editor

The Women's Life Center of The Semel Institute for Neuroscience and Human BehaviourGeffen School of Medicine at UCLALos Angeles, CA (Burt)

Department of Psychiatry; University of Illinois; Chicago, IL (Miller)

The Motherisk Program; The Hospital for Sick Children; Toronto, Canada;

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To the Editor:

We are writing to express our concerns about some of the conclusions made by Wogelius1 and colleagues in their recent paper. Currently, there is a considerable amount of conflicting information about the safety of antidepressants in pregnancy, causing women and their health-care providers difficulty in making an evidence-based decision as to whether or not to treat depression with pharmacotherapy. Since studies finding increased risk tend to receive more media attention,2 it is particularly important that they be rigorously conducted and the findings and conclusions carefully analyzed and presented.

We feel that the authors overstepped the limitations of the study methodology with some of their conclusions for the following reasons: 1) There was no pattern of specific defects, and this lack of specificity is generally considered an indication that teratogenicity is an unlikely explanation. 2) There was no separation of major versus minor congenital anomalies, and minor anomalies, by definition, cause no functional impairment.3 This distinction is of the utmost clinical importance, and omitting it from the analyses markedly limits the clinical usefulness of the study's data. 3) As this was a prescription-events monitoring study, it was not known whether the medications were actually taken by the women. 4) Psychiatrically-ill patients frequently use other psychotropic medications, alcohol and illicit drugs, and these potential confounders were not addressed in this study. 5) Finally, there was no control for maternal illness. This is of great importance because exposure of a fetus to antenatal maternal depression, stress or anxiety may have direct adverse effects on the offspring.4 Major depression when untreated may result in dangerous self-neglect, with disorganized thoughts and behavior. This is particularly worrying during pregnancy, for it may result in smaller babies, preterm labor, and other obstetrical difficulties.5

Vivien Burt

The Women's Life Center of The Semel Institute for Neuroscience and Human BehaviourGeffen School of Medicine at UCLALos Angeles, CA

Laura Miller

Department of Psychiatry University of Illinois Chicago, IL

Adrienne Einarson

The Motherisk Program The Hospital for Sick Children Toronto, Canada

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1. Wogelius P, Nørgaard M, Gislum M, et al. Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations. Epidemiology. 2006;17:701–704.
2. Einarson A, Schachtschneider A, Halil R, et al. SSRI'S and other antidepressant use during pregnancy and potential neonatal adverse effects: Impact of a public health advisory and subsequent reports in the news media. BMC Pregnancy Childbirth. 2005;5:11.
3. Holmes LB. Need for inclusion and exclusion criteria for the structural abnormalities recorded in children born from exposed pregnancies. Teratology. 1999;59:1–2.
4. Rubinow DR. Antidepressant treatment during pregnancy: between Scylla and Charybdis. Am J Psychiatry. 2006;163:954–956.
5. Jablensky AV, Morgan V, Zubrick SR, et al. Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry. 2005;162:79–91.
© 2007 Lippincott Williams & Wilkins, Inc.