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Antidepressant use in pregnancy and severe cardiac malformations: Danish register-based study

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Kolding, L ; Ehrenstein, V ; Pedersen, L ; Sandager, P ; Petersen, O B ; Uldbjerg, N ; Pedersen, L H. / Antidepressant use in pregnancy and severe cardiac malformations : Danish register-based study. I: BJOG : an international journal of obstetrics and gynaecology. 2021 ; Bind 128, Nr. 12. s. 1949-1957.

Bibtex

@article{7568a04976974738910115b08adc144e,
title = "Antidepressant use in pregnancy and severe cardiac malformations: Danish register-based study",
abstract = "OBJECTIVE: Studies restricted to live births may underestimate severe teratogenic effects. We address the limitation by including data from both prenatal and postnatal diagnoses of cardiac malformations.DESIGN: Register-based study.SETTING: Denmark.POPULATION: 364 012 singleton pregnancies from 2007 to 2014.METHODS: We used data from five nationwide registries. Exposure to antidepressants was measured using redeemed prescriptions.MAIN OUTCOME MEASURES: Pregnancies with cardiac malformations that end in miscarriage, termination, stillbirth, postnatal death or cardiac surgery <1 year of birth were classified as severe cardiac malformations (SCM). Propensity scores with adjusted prevalence ratios (PRs) were calculated.RESULTS: SCM were reported in 972 of 364 012 pregnancies overall and in 16 of 4105 exposed. For venlafaxine, the PR for SCM was 2.13 (95% confidence interval [CI] 0.89-5.13), 1.73 (95% CI 1.08-2.77) for other cardiac malformations, and there was a cluster of hypoplastic left heart syndromes (HLHS) (crude PR 17.4 [95% CI 6.41-47.2]), none of which ended in a live birth. For HLHS, the absolute risk increase was 4.4/1000 and the number needed to harm was 225. For selective serotonin reuptake inhibitors, the PRs were 1.09 (95% CI 0.52-2.30) and 1.38 (95% CI 1.00-1.92) for SCM and other cardiac malformations, respectively.CONCLUSIONS: Pregnancy exposure to venlafaxine is associated with an increased risk of severe cardiac malformations but with a low absolute risk. Potential mechanisms include direct effects or confounding by indication. Venlafaxine exposure is a marker for risk pregnancies for which fetal echocardiography may be considered.TWEETABLE ABSTRACT: Exposure to venlafaxine is associated with an increased risk of cardiac malformations but with a low absolute risk.",
author = "L Kolding and V Ehrenstein and L Pedersen and P Sandager and Petersen, {O B} and N Uldbjerg and Pedersen, {L H}",
note = "{\textcopyright} 2021 John Wiley & Sons Ltd.",
year = "2021",
month = nov,
doi = "10.1111/1471-0528.16772",
language = "English",
volume = "128",
pages = "1949--1957",
journal = "BJOG: An International Journal of Obstetrics and Gynaecology",
issn = "1470-0328",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "12",

}

RIS

TY - JOUR

T1 - Antidepressant use in pregnancy and severe cardiac malformations

T2 - Danish register-based study

AU - Kolding, L

AU - Ehrenstein, V

AU - Pedersen, L

AU - Sandager, P

AU - Petersen, O B

AU - Uldbjerg, N

AU - Pedersen, L H

N1 - © 2021 John Wiley & Sons Ltd.

PY - 2021/11

Y1 - 2021/11

N2 - OBJECTIVE: Studies restricted to live births may underestimate severe teratogenic effects. We address the limitation by including data from both prenatal and postnatal diagnoses of cardiac malformations.DESIGN: Register-based study.SETTING: Denmark.POPULATION: 364 012 singleton pregnancies from 2007 to 2014.METHODS: We used data from five nationwide registries. Exposure to antidepressants was measured using redeemed prescriptions.MAIN OUTCOME MEASURES: Pregnancies with cardiac malformations that end in miscarriage, termination, stillbirth, postnatal death or cardiac surgery <1 year of birth were classified as severe cardiac malformations (SCM). Propensity scores with adjusted prevalence ratios (PRs) were calculated.RESULTS: SCM were reported in 972 of 364 012 pregnancies overall and in 16 of 4105 exposed. For venlafaxine, the PR for SCM was 2.13 (95% confidence interval [CI] 0.89-5.13), 1.73 (95% CI 1.08-2.77) for other cardiac malformations, and there was a cluster of hypoplastic left heart syndromes (HLHS) (crude PR 17.4 [95% CI 6.41-47.2]), none of which ended in a live birth. For HLHS, the absolute risk increase was 4.4/1000 and the number needed to harm was 225. For selective serotonin reuptake inhibitors, the PRs were 1.09 (95% CI 0.52-2.30) and 1.38 (95% CI 1.00-1.92) for SCM and other cardiac malformations, respectively.CONCLUSIONS: Pregnancy exposure to venlafaxine is associated with an increased risk of severe cardiac malformations but with a low absolute risk. Potential mechanisms include direct effects or confounding by indication. Venlafaxine exposure is a marker for risk pregnancies for which fetal echocardiography may be considered.TWEETABLE ABSTRACT: Exposure to venlafaxine is associated with an increased risk of cardiac malformations but with a low absolute risk.

AB - OBJECTIVE: Studies restricted to live births may underestimate severe teratogenic effects. We address the limitation by including data from both prenatal and postnatal diagnoses of cardiac malformations.DESIGN: Register-based study.SETTING: Denmark.POPULATION: 364 012 singleton pregnancies from 2007 to 2014.METHODS: We used data from five nationwide registries. Exposure to antidepressants was measured using redeemed prescriptions.MAIN OUTCOME MEASURES: Pregnancies with cardiac malformations that end in miscarriage, termination, stillbirth, postnatal death or cardiac surgery <1 year of birth were classified as severe cardiac malformations (SCM). Propensity scores with adjusted prevalence ratios (PRs) were calculated.RESULTS: SCM were reported in 972 of 364 012 pregnancies overall and in 16 of 4105 exposed. For venlafaxine, the PR for SCM was 2.13 (95% confidence interval [CI] 0.89-5.13), 1.73 (95% CI 1.08-2.77) for other cardiac malformations, and there was a cluster of hypoplastic left heart syndromes (HLHS) (crude PR 17.4 [95% CI 6.41-47.2]), none of which ended in a live birth. For HLHS, the absolute risk increase was 4.4/1000 and the number needed to harm was 225. For selective serotonin reuptake inhibitors, the PRs were 1.09 (95% CI 0.52-2.30) and 1.38 (95% CI 1.00-1.92) for SCM and other cardiac malformations, respectively.CONCLUSIONS: Pregnancy exposure to venlafaxine is associated with an increased risk of severe cardiac malformations but with a low absolute risk. Potential mechanisms include direct effects or confounding by indication. Venlafaxine exposure is a marker for risk pregnancies for which fetal echocardiography may be considered.TWEETABLE ABSTRACT: Exposure to venlafaxine is associated with an increased risk of cardiac malformations but with a low absolute risk.

UR - http://www.scopus.com/inward/record.url?scp=85108248720&partnerID=8YFLogxK

U2 - 10.1111/1471-0528.16772

DO - 10.1111/1471-0528.16772

M3 - Journal article

C2 - 34036715

VL - 128

SP - 1949

EP - 1957

JO - BJOG: An International Journal of Obstetrics and Gynaecology

JF - BJOG: An International Journal of Obstetrics and Gynaecology

SN - 1470-0328

IS - 12

ER -

ID: 68198160