Risk of Congenital Heart Disease in Newborns with Prenatal Exposure to Anti-depressant Medications

Abstract

Introduction It is uncertain whether the use of selective serotonin-reuptake inhibitors (SSRI) and other anti-depressants during pregnancy is associated with an increased risk of congenital heart disease (CHD) in newborn. There have been various studies showing a number of adverse outcomes, including gestational hypertension, reduced birth weight, altered neonatal pain responses and persistent pulmonary hypertension of the newborn with exposure to anti-depressant medications. There have been very few longitudinal studies showing CHD association with the use of anti-depressant medications. Our objective is to examine the risk for congenital heart disease of the newborn associated with prenatal exposure to antidepressant medication. Methods We reviewed charts of mothers who were referred for a fetal echocardiogram between January 1 st , 2009 and December 31 st , 2014. We identified mothers who were exposed to antidepressant medications prenatally. Fetal echocardiograms for these patients were reviewed by two fetal cardiologists and each was blinded to the others' findings. Results A total of 40 patients were identified with prenatal exposure to SSRI. Seven (18%) out of these 40 were found to have a form of CHD. Two fetuses whose mothers were exposed to fluoxetine during pregnancy had large posteriorly malaligned ventricular septal defect, sub-aortic stenosis and critical coarctation identified on fetal echocardiogram. Exposure to citalopram during pregnancy was found to be associated with a moderate size secundum atrial septal defect on one patient and a moderate size mid muscular ventricular septal defect seen on fetal echocardiogram in another patient. Exposure to venlafaxine during pregnancy showed two small muscular ventricular septal defects on fetal echocardiogram on one patient and ductal constriction with increased ductal velocity on another patient. One of the women on escitalopram had a fetus with a large membranous ventricular septal defect (VSD), secundum atrial septal defect (ASD) and left superior vena cava. None of the women on a combination of drugs had CHD. Conclusion There is a risk of congenital heart disease in patients who are prenatally exposed to anti-depressant medications as evident by the specific echocardiographic abnormalities noted in the study.

Nonmedical Determinants of Congenital Heart Diseases in Children from the Perspective of Mothers: A Qualitative Study in Iran

“…Along with our study, other research has shown that cultural issues, including the consequences of an unhealthy\ lifestyle, are important in CHD. Mothers who often had unwanted pregnancies and used various drugs during pregnancy were at higher risk of giving birth to children with CHD [ 50 , 51 ]. According to the findings, the lifestyle of mothers with CHD children was far from health awareness, and going to a doctor or following medical measures was not important for them.…”

High-Throughput 3D-Printed Model of the Feto-Maternal Interface for the Discovery and Development of Preterm Birth Therapies

“…The lack of success in translating current preclinical drug trials into clinical practices can partly be attributed to (1) lack of adequate models of human FMi or impracticality to sample these tissues for studies during pregnancy, (2) placental perfusion studies are restricted to the placental–decidual interface, and drugs passage through the fetal membrane–decidual interface is not tested, confounding data and causing disruptions in clinical trials, (3) anatomical and endocrinological differences between most animal models and humans, and (4) not having studied fetal membrane–decidual FMi’s drug transport functions. In addition, many drugs currently cannot be used during pregnancy as their adverse effects on pregnancy are either unknown or cannot be easily tested. − …”

Characterization of pregnancies exposed to St. John’s wort and their outcomes: A claims data analysis

“…Serotonin plays an important role as a signaling molecule in several aspects of the development of an embryo including the genesis of the heart. In children exposed to SSRIs during the first trimester, an increased risk of septal defects, and also specifically atrial septal defects was observed in several studies 25,[42][43][44][45][46][47][48] . The same applies to selective serotonin norephedrine reuptake inhibitors (SSNRIs) 25,49 .…”