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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.

Authors

Lu Ban lu.ban@nottingham.ac.ukl

JACK GIBSON jack.gibson@nottingham.ac.uk
Assistant Professor in Epidemiology

JOE WEST JOE.WEST@NOTTINGHAM.AC.UK
Professor of Epidemiology

LINDA FIASCHI LINDA.FIASCHI@NOTTINGHAM.AC.UK
Senior Research Fellow in Ehealth

Rachel Sokal

Liam Smeeth

P. Doyle

RICHARD HUBBARD richard.hubbard@nottingham.ac.uk
Blf/Gsk Professor of Epidemiological Resp Research



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.

Journal Article Type Article
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
APA6 Citation Ban, L., Gibson, J. E., West, J., Fiaschi, L., Sokal, R., Smeeth, L., …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
DOI https://doi.org/10.1111/1471-0528.12682
Keywords Antidepressants; Congenital anomaly; Depression; SSRIs; TCAs
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12682/full
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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