General Obstetrics and Gynecology: Obstetrics
Citalopram use in pregnancy: Prospective comparative evaluation of pregnancy and fetal outcome

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Objective

Citalopram is a selective serotonin reuptake inhibitor indicated for depression. The safety of this medication in pregnancy has not been fully established. The purpose of this study was to investigate whether citalopram is associated with an increased incidence of adverse pregnancy outcomes.

Study design

Pregnant women who contacted the Motherisk Program, a Teratogen Information Center in Toronto, Ontario, with regard to the safety of citalopram in pregnancy were enrolled in the study. The exposed women were matched to a disease-matched group of women and a nonteratogenic group. All women were matched for age (± 2 years) and gestational age at time of first call to the Motherisk (± 2 weeks). A structured telephone follow-up interview was conducted following the expected date of confinement.

Results

The total number of pregnant women enrolled in this study was 396 (132 women in each group). A total of 125 women took citalopram at least in the first trimester. Seventy-one (54%) women continued to take the drug throughout pregnancy. One hundred fourteen women (86%) had live births, 14 (11%) had spontaneous abortions, 2 (1.5%) had elective terminations, and 2 (1.5%) experienced stillbirths. Fetal survival rates, mean birth weights, and duration of pregnancy were not statistically different among the 3 groups. Of 108 live-born infants whose mothers were exposed to citalopram in the first trimester, there was 1 (0.9%) male infant born with a major malformation. There was a relative risk of 4.2 (95% confidence interval 1.71-10.26) in neonates exposed to citalopram close to term to be admitted to special-care nurseries as compared with the unexposed infants.

Conclusion

Citalopram use during the period of embryogenesis in pregnancy is not associated with an apparent major teratogenic risk. Late pregnancy use of citalopram is associated with increased risk of poor neonatal adaptation syndrome, recently described with other selective serotonin reuptake inhibitors.

Section snippets

Objectives

The objective of our study was to determine whether citalopram use during pregnancy is associated with an increased risk of adverse pregnancy outcome, including birth defects and neonatal complications.

Patients and methods

This was a prospective comparative study with 2 matched comparison groups (a disease-matched and a nonteratogen group).

The study was conducted by the Motherisk Program at the Hospital for Sick Children in Toronto. The Motherisk Program is a teratogen information and counseling center that provides pregnant or breast-feeding women and their health care providers with evidence-based information on the safety/risk of exposures to prescription and over-the-counter medications, natural health

Maternal characteristics

The total number of pregnant women enrolled in this study was 396 (132 women in each study group). Pregnant women who were exposed to citalopram had a mean age of 31.9 ± 4.8 years (range 18-42 years). At the time of study recruitment, 108 of 132 women were already pregnant with the mean gestational age of pregnancy of 8.8 ± 7.8 weeks (range 1-39 weeks). Twenty-four women were still planning their pregnancy at the time of their first contact with Motherisk. Dosing schedule of citalopram in the

Comment

Although several published studies21, 22, 23, 24, 25, 26 did not associate SSRI antidepressants with major malformations or neurobehavioral problems, many pregnant women and their health care providers are apprehensive with regard to SSRI therapy during pregnancy.

To our knowledge, this study is the first prospective comparative study to examine the possible adverse effects of citalopram during pregnancy. We found only 1 male infant born with a major birth defect following exposure to citalopram

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    Supported in part by the Research Leadership for Better Pharmacotherapy During Pregnancy and Lactation.

    Gideon Koren is a Senior Scientist of the Canadian Institutes for Health Research and holder of the Ivey Chair in Molecular Toxicology, The University of Western Ontario.

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