Context.— Although a large number of women of reproductive age use new selective
serotonin reuptake inhibitors (SSRIs) and half of all pregnancies are unplanned,
no data exist on the safety of these agents for the human fetus.
Objective.— To assess fetal safety and risk of fluvoxamine, paroxetine, and sertraline.
Design.— A prospective, multicenter, controlled cohort study.
Setting.— Nine Teratology Information Service centers in the United States and
Patients.— All women who were counseled during pregnancy following exposure to
a new SSRI and followed up by the participating centers. Controls were randomly
selected from women counseled after exposure to nonteratogenic agents.
Main Outcome Measures.— Rates of major congenital malformations.
Results.— A total of 267 women exposed to an SSRI and 267 controls were studied.
Exposure to SSRIs was not associated with either increased risk for major
malformations (9/222 live births [4.1%] vs 9/235 live births [3.8%] in the
controls, relative risk, 1.06, 95% confidence interval, 0.43-2.62) or higher
rates of miscarriage, stillbirth, or prematurity. Mean (SD) birth weights
among SSRI users (3439  g) were similar to the controls (3445  g)
as were the gestational ages (39.4 [1.7] weeks vs 39.4 [1.9] weeks).
Conclusion.— The new SSRIs, fluvoxamine, paroxetine, and sertraline, do not appear
to increase the teratogenic risk when used in their recommended doses.