Exposure to selective noradrenalin reuptake inhibitors during the first trimester of pregnancy and risk of congenital malformations: A meta-analysis of cohort studies

• Published in: Psychiatry research 2022-10, Vol.316, p.114756-114756, Article 114756
• Main Authors: Lou, Zhuo-qi, Zhou, Yuan-yue, Zhang, Xue, Jiang, Hai-yin
• Format: Article
• Language: English
• Subjects: Antidepressant; Congenital anomaly; Fetotoxic effects; Reproductive
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2022.114756

•It remains controversial whether SNRI use during pregnancy is associated with an increased risk of congenital malformations.•Our study shows that maternal SNRI exposure was not associated with overall congenital malformations.•An observed increased risk of cardiac malformations can be explained by maternal psychiatric disorders.•No evidence of an increased risk for other congenital malformations was found in our analysis. Selective serotonin-noradrenalin reuptake inhibitors (SNRIs) are used to treat depression and anxiety during pregnancy; however, information regarding their foetal safety is limited. Cohort studies concerning congenital malformations in infants born to mothers exposed to SNRIs during the first trimester of pregnancy were identified. Eight studies were included in the analysis. In general, the use of SNRIs was not associated with an increased risk of overall congenital malformations when compared with no exposure (rate ratio [RR] = 1.07, 95% confidence interval [CI] = 0.94–1.22; P = 0.31), exposure to SSRIs (RR = 1.12, 95% CI = 0.97–1.31; P = 0.12) and no exposure with clinical indication (RR = 1.04, 95% CI = 0.9–1.2; P = 0.564). A significantly increased risk of cardiac malformations was observed (RR = 1.33, 95% CI = 1.15–1.53; P