630 - Maternal SSRI Exposure During Pregnancy and Neonatal Cardiopulmonary Outcomes: A Systematic Review and Meta-Analysis

Publication Number: 4616.630

Sree Mahathi Chavali, New York Presbyterian Brooklyn Methodist, brooklyn, NY, United States; Maneeth Mylavarapu, Endeavor Health Cardiovascular Vascular Institute, Glenview, IL, United States; Naga Pratyusha Cheruvu, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States; Sruthi Veldurthy, Mediciti Institute of Medical Sciences, Houston, TX, United States; Vaibhav Shandilya, ESIC Medical College and Hospital, Hyderabad, Telangana, India

Background: Maternal depression and anxiety are prevalent during pregnancy, often leading to the prescription of selective serotonin reuptake inhibitors (SSRIs). While essential for maternal well-being, concerns exist regarding the potential impact of in-utero SSRI exposure on neonatal cardiopulmonary outcomes, specifically the risk of congenital heart defects (CHDs).

Objective: Maternal SSRI exposure is associated with an increased risk of these neonatal cardiopulmonary outcomes.

Design/Methods: This study employed a systematic review and meta-analysis of observational studies. We comprehensively searched major electronic databases PubMed, Web of Science, and Google Scholar. Included studies compared neonatal cardiopulmonary outcomes in infants exposed to SSRIs during pregnancy with those unexposed. Primary endpoints constitute any cardiovascular malformation, and secondary endpoints include specific CHD, i.e., atrial septal defect (ASD), ventricular septal defect (VSD), and persistent pulmonary hypertension (PPHN). Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the binary random- effects model. A p-value ≤ 0.05 was considered statistically significant.

Results: A total of 22 observational (20 cohort, 2 case-control) studies with 74,850 infants born with cardiovascular malformations were included in our analysis. Pregnant women who used SSRIs had a significantly increased risk of infant cardiovascular-related malformations (RR 1.26; 1.13 - 1.39; p=0.003), ASD (RR 2.06; 1.40 - 3.03; p=0.037). Although the risk of VSD (RR 1.15; 0.97 – 1.36; p=0.197) and PPHN (RR 1.30; 0.76 – 2.21; p=0.98) were also increased in infants following maternal SSRI usage, these associations did not reach statistical significance.

Conclusion(s): This meta-analysis reveals a significant association between maternal SSRI exposure and an increased risk of overall cardiopulmonary adverse outcomes in infants, underscoring the need for careful risk-benefit assessment in pregnancy SSRI prescription and enhanced prenatal counseling. While non-significant trends for VSD and PPHN were observed, the findings highlight the importance of heightened postnatal surveillance for cardiac anomalies in exposed infants and call for further research into specific SSRI effects and underlying mechanisms to optimize maternal mental health care and fetal safety.