Selective serotonin reuptake inhibitors and malformations: case closed?

Selective serotonin reuptake inhibitors (SSRIs) are widely used by pregnant women due to the high rates of depression among reproductive-age women. Several studies based on administrative databases reported an increased risk of cardiac malformations among infants of pregnant users. This has caused anxiety and fears among expecting women and their physicians, often leading to discontinuation of much-needed therapies. Recent decisive evidence documented a similar higher risk of cardiac malformations among depressed women not taking SSRIs during pregnancy. The most likely reason is ascertainment bias, with depressed women, treated or untreated, undergoing significantly more diagnostic tests in their children. These data strongly support the view that SSRIs do not increase the risk of cardiovascular malformations.