Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study

Ban, Lu; Gibson, Jack E.; West, Joe; Fiaschi, Linda; Sokal, Rachel; Smeeth, Liam; Doyle, P.; Hubbard, Richard B.; Tata, Laila J.

Abstract

OBJECTIVE: 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. DESIGN: Population-based cohort study.

SETTING: Linked UK maternal–child primary care records.

POPULATION: A total of 349 127 singletons liveborn between 1990 and 2009.

METHODS: 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.

MAIN OUTCOME MEASURES: Fourteen system-specific MCA groups classified according to the European Surveillance of Congenital Anomalies and five specific heart anomaly groups. RESULTS: 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).

CONCLUSIONS: 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.

Citation

Ban, L., Gibson, J. E., West, J., Fiaschi, L., Sokal, R., Smeeth, L., Doyle, P., Hubbard, R. B., & Tata, L. J. (in press). Maternal depression, antidepressant prescriptions, and congenital anomaly risk in offspring: a population-based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology, 121(12), https://doi.org/10.1111/1471-0528.12682

• Journal Article Type: Article
• Acceptance Date: Dec 22, 2013
• Online Publication Date: Mar 11, 2014
• Deposit Date: Dec 15, 2016
• Publicly Available Date: Dec 15, 2016
• Journal: BJOG: An International Journal of Obstetrics and Gynaecology
• Print ISSN: 1470-0328
• Electronic ISSN: 1471-0528
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 121
• Issue: 12
• DOI: https://doi.org/10.1111/1471-0528.12682
• Keywords: Antidepressants; Congenital anomaly; Depression; SSRIs; TCAs
• Public URL: https://nottingham-repository.worktribe.com/output/725217
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12682/full
• Contract Date: Dec 15, 2016