Antidepressant Use in Pregnancy and the Risk of Cardiac Defects

Antidepressant Use in Pregnancy and the Risk of Cardiac Defects

Aleksander Kempny MD, Lorna Swan MB ChB MD FRCP, Konstantinos Dimopoulos MD MSc PhD FESC

Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK

National Heart and Lung Institute, Imperial College School of Medicine, London, UK

We declare that we have no conflict of interest.

Correspondence to:

Dr. Aleksander Kempny

Adult Congenital Heart Centre

Royal Brompton and Harefield NHS Foundation Trust

Sydney Street, SW3 6NP London, UK

Tel+44 207351 8602, Fax+44 207351 8629

E-mail:

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Huybrechts et al. report no significant increase of cardiac malformations attributable to antidepressant use during the first trimester of pregnancy.

Great care should be taken when suggesting that any medication does not lead to an increase in fetal malformations. Cardiac lesions have previously been linked to antidepressant use and can increase mortality, morbidity and reduce life expectancy. Patients may require complex interventions and lifelong follow-up, which may impact not only child but also maternal health and wellbeing.

Improving maternal mood over the first trimester using antidepressants may be certainly important in selected cases, but any increased fetal risk needs to be considered clinically relevant in the view of the life-long consequences.

Only essential mediation with good tract record of safey should be presribed in pregnancy and in not case should antidepressants be liberlly used .

Table S18 shows increased odds ratio for heart defects with increasing number of drug dispensing. The Authors considered antidepressant exposure, however, if there was any overlap of drug prescription with the first trimester, independent of the number of days the drug was taken. Moreover, even clinical trials report average adherence rates of only 43 to 78 percent. This may cause significant underestimation of the effect of antidepressants on the incidence of congenital heart defects. Taking this into account as well as the discrepancies with previously published reports, still caution is needed when prescribing antidepressants and patients still need to be informed about the potentially increased risk as well as the life long consequences of congenital heart defects.

Finally, it would be important to inform readers on the proportion of missing data, if any, especially in parameters used to construct the propensity scores. In fact, patients with a single missing parameter would automatically be excluded from the analysis, possibly introducing bias, unless methods to account for missing data are utilized (e.g. multiple imputation).

References

1.Huybrechts KF, Palmsten K, Avorn J et al. Antidepressant Use in Pregnancy and the Risk of Cardiac Defects. N Engl J Med 2014;370:2397-2407.

2.Osterberg L, Blaschke T. Adherence to medication. N Engl J Med 2005;353:487-97.

3.Pedersen LH, Henriksen TB, Vestergaard M, Olsen J, Bech BH. Selective serotonin reuptake inhibitors in pregnancy and congenital malformations: population based cohort study. BMJ 2009;339:b3569.

4.Bérard A, Ramos E, Rey E, Blais L, St-André M, Oraichi D. First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage. Birth Defects Res B Dev Reprod Toxicol 2007;80:18-27.