Synthesizing Cohort Study Results to Promote Knowledge Transfer of Safety Data Regarding Gestational Antidepressant Exposure and Offspring Congenital Anomalies: A Test of Concept

Background

Health practitioners tend to overestimate potential risks to pregnancy from antidepressant (AD) exposure. Through a literature review focused on major congenital anomalies (MCA) and cardiac anomalies (CA) in association with gestational AD exposure, we evaluated the strength of the available evidence and explored ways to facilitate communication of the evidence to providers and patients.

Methods

In PubMed, we searched English language publications, from January 2013 to March 2024, using search terms for ADs and MCA to identify cohort studies that took steps to minimize confounding and misclassification bias. We extracted study relative risks (RR) for the association between ADs and anomalies. We meta-analyzed the RR and developed a fact box to streamline risk communication.

Results

Of 1308 articles identified, 111 were retained after abstract review, of which 13 met our inclusion criteria. The pooled RR values for any AD were 1.06 (95% CI: 1.00–1.13) for MCA and 1.10 (95% CI: 1.01–1.19) for CA. Results were similar when focusing on individual AD drug classes. Risks were depicted on the absolute scale using an icon array in a fact box.

Conclusions

Reassuring quantitative data regarding prenatal AD exposure and the risk of MCA/CA are buried within a large corpus of publications. The fact box provides a quantitative, visual, and verbal description of absolute risks, based on pooled estimates from cohort studies which took steps to minimize bias. Further study is needed to examine the potential for fact boxes to increase clinician knowledge, clinician confidence to engage in risk discussions with patients, and patient understanding of the risk data.