Evidence of an association between early pregnancy exposure to
selective serotonin reuptake inhibitors (SSRI) and
congenital heart defects (CHD) has contributed to recommendations to weigh benefits and risks carefully. The objective of this study was to determine the specificity of association between first trimester exposure to
SSRIs and specific CHD and other congenital anomalies (CA) associated with SSRI exposure in the literature (signals). A population-based case-malformed control study was conducted in 12 EUROCAT CA registries covering 2.1 million births 1995-2009 including livebirths,
fetal deaths from 20 weeks gestation and terminations of pregnancy for
fetal anomaly. Babies/fetuses with specific CHD (n = 12,876) and non-CHD signal CA (n = 13,024), were compared with malformed controls whose diagnosed CA have not been associated with SSRI in the literature (n = 17,083). SSRI exposure in first trimester pregnancy was associated with CHD overall (OR adjusted for registry 1.41, 95% CI 1.07-1.86,
fluoxetine adjOR 1.43 95% CI 0.85-2.40,
paroxetine adjOR 1.53, 95% CI 0.91-2.58) and with severe CHD (adjOR 1.56, 95% CI 1.02-2.39), particularly
Tetralogy of Fallot (adjOR 3.16, 95% CI 1.52-6.58) and
Ebstein's anomaly (adjOR 8.23, 95% CI 2.92-23.16). Significant associations with SSRI exposure were also found for ano-rectal atresia/
stenosis (adjOR 2.46, 95% CI 1.06-5.68),
gastroschisis (adjOR 2.42, 95% CI 1.10-5.29), renal dysplasia (adjOR 3.01, 95% CI 1.61-5.61), and
clubfoot (adjOR 2.41, 95% CI 1.59-3.65). These data support a teratogenic effect of
SSRIs specific to certain anomalies, but cannot exclude confounding by indication or associated factors.