BACKGROUND:The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial. METHODS:We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study. RESULTS:In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects. CONCLUSIONS:Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.

译文

背景:产前暴露于选择性5-羟色胺再摄取抑制剂(SSRIs)后出生缺陷的风险仍然存在争议。
方法:我们评估了参加妊娠流行病学中心出生缺陷研究的9849例婴儿和5860例无出生缺陷的婴儿中,孕妇在孕早期使用SSRI与出生缺陷风险之间的相关性。
结果:在先前与SSRI使用相关的缺陷分析中(涉及42个比较),SSRI的整体使用与颅突狭窄的风险显着增加无关(115名受试者,有2名暴露于SSRI中;比值比为0.8; 95%置信区间[CI] ],0.2到3.5),全卵裂(127名受试者,暴露3;比值比,1.4; 95%CI,0.4到4.5)或整体心脏缺陷(3724名受试者,暴露100,比值比,1.2,95%CI,0.9)至1.6)。对单个SSRI与特定缺陷之间的关联进行的分析显示,使用舍曲林和卵母囊肿(赔率,5.7; 95%CI,1.6至20.7; 3个暴露的受试者)与间隔缺损(赔率,2.0; 95%CI)之间存在显着关联。 ; 1.2至4.0; 13位暴露的受试者)以及在帕罗西汀和右室流出道阻塞缺陷之间的使用(赔率,3.3; 95%CI,1.3至8.8; 6位暴露的受试者)。其他缺陷或其他SSRI或非SSRI抗抑郁药的风险未显着或显着增加。涉及66个比较的探索性分析表明,帕罗西汀和舍曲林可能与其他特定缺陷有关。
结论:我们的研究结果并未表明与SSRI的使用相关的颅前突增生,卵泡扩张或心脏缺陷的风险显着增加。他们认为,单个SSRI可能会增加某些特定缺陷的风险,但是应该认识到,所涉及的特定缺陷很少,绝对风险也很小。

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