Antidepressant use during first trimester not associated with risk of major congenital malformations.

ED FROM Ramos E, St-André M, Rey E, et al. Duration of antidepressant use during pregnancy and risk of major congenital malformations. Br J Psychiatry 2008;192:344–50. Correspondence to: Dr Anick Berard, CHU Sainte-Justine, Research Center, 3175 chenin de la Cote-Ste-Catherine, Montreal, Quebec H3T 1C5, Canada; [email protected] Source of funding: Fonds de la Recherche en Sante du Quebec (grant 6263), Reseau Quebecois de Recherche sur l’Usage des Medicaments and the FRSQ Network for the Wellbeing of Children. C O M M EN TA R Y T here is increasing recognition that, despite the dominance of postnatal psychiatric disorders in the psychiatric research literature, disorders such as depression are also common during pregnancy, are associated with considerable morbidity for the pregnant woman and can lead to adverse outcomes for the fetus and subsequent poorer long term outcomes for the child. Although clinicians do use antidepressants during pregnancy, concerns remain about the potential harm of antidepressants for the exposed fetus, including risk of congenital malformations, neonatal syndrome and longer term adverse behavioural outcomes. This paper seeks to investigate whether duration of exposure during the first trimester increases the risk of major congenital malformations using administrative databases and finds no association between antidepressant use during the first trimester and major congenital malformations. Limitations of this study include the lack of knowledge on whether prescribed antidepressants have been taken (or when they were taken). In addition, the study population is unusual in that nearly half are on welfare benefits. It is unclear why this group had a particularly high rate (8%) of major congenital malformations but the high rates of other prescribed potentially teratogenic medications (including anticonvulsants and anxiolytics) may have contributed to this finding. There was also a failure to adequately adjust for severity of disorder during pregnancy, limited knowledge of the exact timing of gestational exposure (exposure during different weeks within the first gestation may have a differential effect) and too small a study population to investigate individual antidepressants and their specific risk of congenital malformations. Nevertheless, this study provides some further reassurance to clinicians when prescribing antidepressants during the first trimester and adds to the rapidly changing evidence base in this field. It is difficult but important for clinicians to be up to date with this evidence in order to provide pregnant women with comprehensive information on the risks and benefits of taking medication. Such decisions also continue to be dependent on the psychiatric history and the severity of the antenatal depression. Dr Louise Howard, PhD, MRCPsych Section of Community Mental Health, Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK Competing interests: None. 1. NICE. Antenatal and postnatal mental health. The NICE guideline on clinical management and service guidance. CG45. London: National Institute for Health and Clinical Excellence, 2007. Aetiology 28 EBMH February 2009 Vol 12 No 1 group.bmj.com on June 18, 2017 Published by http://ebmh.bmj.com/ Downloaded from