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A Systematic Review and Meta-Analysis Considering the Risk for Congenital Heart Defects of Antidepressant Classes and Individual Antidepressants

Author

Listed:
  • Courtney De Vries

    (University of South Australia)

  • Svetla Gadzhanova

    (University of South Australia)

  • Matthew J. Sykes

    (University of South Australia)

  • Michael Ward

    (University of South Australia
    University of South Australia)

  • Elizabeth Roughead

    (University of South Australia)

Abstract

Introduction Antidepressant use during the first trimester is reported in 4–8% of pregnancies. The use of some selective serotonin reuptake inhibitors during the first trimester has been identified as increasing the odds for congenital heart defects; however, little is known about the safety of non-selective serotonin reuptake inhibitor antidepressants. Objective The objective of this study was to assess the odds of congenital heart defects associated with the use of antidepressants during the first trimester of pregnancy, and to update the literature as newer studies have been published since the latest systematic literature review and meta-analysis. Methods PubMed and Embase were searched till 3 June, 2020. Study quality was assessed, and study details were extracted. Meta-analyses were performed using RevMan 5.4, which assessed: (1) any antidepressant usage; (2) classes of antidepressants; and (3) individual antidepressants. Results Twenty studies were identified, encompassing 5,337,223 pregnancies. The odds ratio for maternal use of any antidepressant during the first trimester of pregnancy and the presence of congenital heart defects from the random effects meta-analysis was 1.28 (95% confidence interval [CI] 1.17–1.41). Significant odds ratios of 1.69 (95% CI 1.37–2.10) and 1.25 (95% CI 1.15–1.37) were reported for serotonin norepinephrine reuptake inhibitors and selective serotonin reuptake inhibitors, respectively. A non-statistically significant odds ratio of 1.02 (95% CI 0.82–1.25) was reported for the tricyclic antidepressants. Analyses of individual SSRIs produced significant odds ratios of 1.57 (95% CI 1.25–1.97), 1.36 (95% CI 1.08–1.72), and 1.29 (95% CI 1.14–1.45) for paroxetine, fluoxetine, and sertraline, respectively. The norepinephrine-dopamine-reuptake inhibitor bupropion also produced a significant odds ratio of 1.23 (95% CI 1.01–1.49). Conclusions The selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor classes of antidepressants pose a greater risk for causing congenital heart defects than the tricyclic antidepressants. However, this risk for individual antidepressants within each class varies, and information regarding some antidepressants is still lacking.

Suggested Citation

  • Courtney De Vries & Svetla Gadzhanova & Matthew J. Sykes & Michael Ward & Elizabeth Roughead, 2021. "A Systematic Review and Meta-Analysis Considering the Risk for Congenital Heart Defects of Antidepressant Classes and Individual Antidepressants," Drug Safety, Springer, vol. 44(3), pages 291-312, March.
  • Handle: RePEc:spr:drugsa:v:44:y:2021:i:3:d:10.1007_s40264-020-01027-x
    DOI: 10.1007/s40264-020-01027-x
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    Cited by:

    1. Georgios Eleftheriou & Riccardo Zandonella Callegher & Raffaella Butera & Marco De Santis & Anna Franca Cavaliere & Sarah Vecchio & Alessandra Pistelli & Giovanna Mangili & Emi Bondi & Lorenzo Somaini, 2023. "Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders," IJERPH, MDPI, vol. 20(16), pages 1-57, August.

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