Smoking and antidepressants: possible causes of congenital heart defects

Smoking and taking certain antidepressants from the group of the selective Serotonin reuptake inhibitors (SSRI) during the first three months of pregnancy could significantly increase the risk of anomalies of the heart (4-fold with Fluoxetin, 3-fold with Paroxetin). This is the result of a multicentre study by Asher Ornoy from the Israeli Teratology Information Service in Jerusalem that was published in the November 2008 edition of the British Journal of Clinical Pharmacology.

In this study, a total of 2,191 depression-prone pregnant women from Israel, Italy and Germany were examined; 410 were given Paroxetin and 314 Fluoxetin. A control group of 1,467 did not take either of these drugs, but were given another drug classified as harmless. The test persons were frequent smokers.

Both antidepressants significantly increased the risk of congenital heart defect; Paroxetin by 2.7-fold, Fluoxetin by 4.5-fold. Smoking increased the risk further; by 2.8-fold if daily consumption was less than 10 cigarettes, and by 5.4-fold if at least 10 cigarettes a day were smoked. Statistically significant is the minimum 4-fold risk, i.e. Fluoxetin treatment as well as smoking.

An estimated one in seven women suffer from clinical depression during pregnancy. Physicians therefore have to carefully weigh up the pros and cons of prescribing medication. The health of the mother and the child has equal priority.

During pregnancy women should refrain from smoking altogether. The authors did not consider it necessary to discontinue SSRI treatment, particularly as most of the heart defects are not of a serious nature and not all require treatment.