Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population‐based cohort study. (11th March 2014)

• Record Type: Journal Article
• Authors: Ban, L; Gibson, JE; West, J; Fiaschi, L; Sokal, R; Smeeth, L; Doyle, P; Hubbard, RB; Tata, LJ
• Is Part Of: BJOG. Volume 121:Number 12(2014:Dec.)
• Page Start: 1471
• Page End: 1481
• Publication Date: 2014-03-11
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12682
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12682-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12682-sec-0001" sec-type="section"> <title>Objective</title> <p>To estimate risks of major congenital anomaly (MCA) among children of mothers prescribed antidepressants during early pregnancy or diagnosed with depression but without antidepressant prescriptions.</p> </sec> <sec id="bjo12682-sec-0002" sec-type="section"> <title>Design</title> <p>Population‐based cohort study.</p> </sec> <sec id="bjo12682-sec-0003" sec-type="section"> <title>Setting</title> <p>Linked UK maternal–child primary care records.</p> </sec> <sec id="bjo12682-sec-0004" sec-type="section"> <title>Population</title> <p>A total of 349 127 singletons liveborn between 1990 and 2009.</p> </sec> <sec id="bjo12682-sec-0005" sec-type="section"> <title>Methods</title> <p>Odds ratios adjusted for maternal sociodemographics and comorbidities (aORs) were calculated for MCAs, comparing women with first‐trimester selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs) and women with diagnosed but unmedicated depression, or women without diagnosed depression.</p> </sec> <sec id="bjo12682-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Fourteen system‐specific MCA groups classified according to the European Surveillance of Congenital Anomalies and five specific heart anomaly groups.</p> </sec> <sec id="bjo12682-sec-0007" sec-type="section"> <title>Results</title> <p>Absolute risks of MCA were 2.7% (95% confidence interval, 95% CI, 2.6–2.8%) in children of mothers without diagnosed depression, 2.8% (95% CI 2.5–3.2%) in children of mothers with unmedicated depression, and 2.7% (95% CI 2.2–3.2%) and 3.1% (95% CI 2.2–4.1%) in children of mothers with SSRIs or TCAs, respectively. Compared with women without depression, MCA overall was not associated with unmedicated depression (aOR 1.07, 95% CI 0.96–1.18), SSRIs (aOR 1.01, 95% CI 0.88–1.17), or TCAs (aOR 1.09, 95% CI 0.87–1.38). Paroxetine was associated with increased heart anomalies (absolute risk 1.4% in the exposed group compared with 0.8% in women without depression; aOR 1.78, 95% CI 1.09–2.88), which decreased marginally when compared with women with diagnosed but unmedicated depression (aOR 1.67, 95% CI 1.00–2.80).</p> </sec> <sec id="bjo12682-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Overall MCA risk did not increase with maternal depression or with antidepressant prescriptions. Paroxetine was associated with increases of heart anomalies, although this could represent a chance finding from a large number of comparisons undertaken.</p> </sec> </abstract>