ACP Journal Club. Use of SSRIs during pregnancy was not associated with increased risk for stillbirth or neonatal mortality.

The study by Jimenez-Solem, along with 2 other important cohort studies (1, 2), provide reasonable data to guide SSRI medication choice for this population. Based on the existing evidence, paroxetine should definitely be avoided. Its use has been associated with congenital, especially cardiac, malformations (1, 2). One could also make a tentative case to be cautious about using citalopram, and keep in mind that the data are limited for its enantiomer—escitalopram. Jimenez-Solem and colleagues found that use of citalopram for all 3 trimesters was associated with increased neonatal mortality risk— aOR 2.13; however, this became statistically nonsignificant after adjustment for multiple comparisons. Risk for neonatal mortality with citalopram was low for first-trimester exposure, higher for firstand second-trimester exposure, and highest for exposure during all 3 trimesters.