Women during their childbearing years are susceptible to depression. In developed countries more than 10% of women take antidepressants during their reproductive life - most commonly selective serotonin reuptake inhibitors (SSRIs). The safety of these drugs in pregnancy is critical and a study by Pedersen et al from Denmark adds to prescribing principles (BMJ 2009; 339: b3569).
The researchers correlated congenital malformations with maternal antidepressant use in half a million children and found no overall increased risk. However the drugs were associated with septal defects of the heart. This was found for all SSRIs, especially when combinations were used or different drugs were prescribed serially. The absolute increase was from a background rate of 0.5% to 0.9% for single medications and 2% for multiple prescriptions.
This risk must be weighed against the dangers of not treating major depression or using psychotherapy. The American College of O&G has stated that women can continue or start SSRI antidepressants in pregnancy but should be appraised of the risks, however small (Chambers BMJ 2009; 339: b3525).
