Use of selective serotonin reuptake inhibitors in pregnancy and cardiac malformations: a propensity‐score matched cohort in CPRD

Margulis, Andrea V.; Abou‐Ali, Adel; Strazzeri, Marian M.; Ding, Yu; Kuyateh, Fatmatta; Frimpong, Eric; Levenson, Mark; Hammad, Tarek A.

doi:10.1002/pds.3462

Cited by 43 publications

(47 citation statements)

References 53 publications

(47 reference statements)

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“…Among 27 articles that were selected for review, no consistent pattern has been observed in the reported risk of CHA. A slight increase in risk was found, particularly for paroxetine, in a number of studies in various countries (see Table S1) [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22], but a number of other studies reported no increased risk (see Table S2) [23,24,25,26,27,28,29,30,31,32]. The dose of SRIs may also be an important determinant of the risk.…”

Section: The Risk Of Congenital Heart Anomalies (Cha) Associated Wmentioning

confidence: 99%

The Risk of Congenital Heart Anomalies Following Prenatal Exposure to Serotonin Reuptake Inhibitors—Is Pharmacogenetics the Key?

Daud

Bergman

Kerstjens-Frederikse

et al. 2016

IJMS

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Serotonin reuptake inhibitors (SRIs) are often prescribed during pregnancy. Previous studies that found an increased risk of congenital anomalies, particularly congenital heart anomalies (CHA), with SRI use during pregnancy have created concern among pregnant women and healthcare professionals about the safety of these drugs. However, subsequent studies have reported conflicting results on the association between CHA and SRI use during pregnancy. These discrepancies in the risk estimates can potentially be explained by genetic differences among exposed individuals. In this review, we explore the potential pharmacogenetic predictors involved in the pharmacokinetics and mechanism of action of SRIs, and their relation to the risk of CHA. In general, the risk is dependent on the maternal concentration of SRIs and the foetal serotonin level/effect, which can be modulated by the alteration in the expression and/or function of the metabolic enzymes, transporter proteins and serotonin receptors involved in the serotonin signalling of the foetal heart development. Pharmacogenetics might be the key to understanding why some children exposed to SRIs develop a congenital heart anomaly and others do not.

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Section: The Risk Of Congenital Heart Anomalies (Cha) Associated Wmentioning

confidence: 99%

The Risk of Congenital Heart Anomalies Following Prenatal Exposure to Serotonin Reuptake Inhibitors—Is Pharmacogenetics the Key?

Daud

Bergman

Kerstjens-Frederikse

et al. 2016

IJMS

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“…These proportions decreased to 40.63% (15 of the 37 per 1000 pregnancies) in the first trimester of pregnancy, 35.87% (six of the 16 per 1000 pregnancies) and 36.43% (six of the 17 per 1000 pregnancies) in respectively the second and third trimesters. Comparable proportions were observed for newly initiated category X drugs.…”

Section: Newly Initiated Drugsmentioning

confidence: 99%

Dispensing of potentially teratogenic drugs before conception and during pregnancy: a population‐based study

Zomerdijk

Ruiter

Houweling

et al. 2014

BJOG

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Objective To study the dispensing of potentially teratogenic drugs in the 12-month period before as well as during pregnancy in the Netherlands.Design Population-based study.Setting A cohort was constructed using a linkage between the PHARMO Database Network and the Netherlands Perinatal Registry (PRN). Mean outcome measures Proportion of pregnancies that received potentially teratogenic drugs in the 12-month period before and during pregnancy and specific for the risk category X drugs and newly initiated drugs.Results Sixteen percent of the pregnancies received a potentially teratogenic drug in the 12-month period before and 5.07% during pregnancy. Doxycycline and paroxetine were most frequently received during pregnancy by 1.01% and 0.85% of women, respectively; 0.66% of the women received a risk category X drug during pregnancy which most frequently consisted of triptorelin (0.25%), norethisterone (0.22%) and simvastatin (0.03%). Fifty-three percent of the women who received a potentially teratogenic drug during pregnancy received this for the first time during the study period. These percentages were heterogeneous between therapeutic drug classes.Conclusions Five percent of the pregnancies received a potentially teratogenic drug during pregnancy and 0.66% received a drug from the risk category X. It may be possible to reduce these proportions when reasons for prescription have been explored.

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“…[1][2][3] Studies concerning the adverse effects of SSRI exposure during gestation on the developing fetus have indicated an increased risk of various congenital malformations, [4][5][6][7][8][9] but inconsistencies between study results remain. [10][11][12][13][14] These could potentially be explained by indication bias where the effect of the drug and the indication are correlated and not fully accounted.…”

mentioning

confidence: 99%

Sertraline use during pregnancy and the risk of major malformations

Bérard

Zhao

Sheehy

2015

American Journal of Obstetrics and Gynecology

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Use of selective serotonin reuptake inhibitors in pregnancy and cardiac malformations: a propensity‐score matched cohort in CPRD

Abstract: The results of this study are most compatible with no association between maternal use of SSRIs in early pregnancy and cardiac malformations or septal defects in the offspring. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Cited by 43 publications

References 53 publications

The Risk of Congenital Heart Anomalies Following Prenatal Exposure to Serotonin Reuptake Inhibitors—Is Pharmacogenetics the Key?

The Risk of Congenital Heart Anomalies Following Prenatal Exposure to Serotonin Reuptake Inhibitors—Is Pharmacogenetics the Key?

Dispensing of potentially teratogenic drugs before conception and during pregnancy: a population‐based study

Sertraline use during pregnancy and the risk of major malformations

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