Advertisement

Maternal use of bupropion and risk for congenital heart defects

Published:April 26, 2010DOI:https://doi.org/10.1016/j.ajog.2010.02.015

      Objective

      We sought to determine if maternal bupropion treatment in early pregnancy is associated with congenital heart defects in the infant.

      Study Design

      We conducted a retrospective case-control study of birth defects risk factors. Data on 6853 infants with major heart defects were compared with 5869 control infants born in 1997–2004. Bupropion exposure was defined as any reported use between 1 month before and 3 months after conception.

      Results

      Mothers of infants with left outflow tract heart defects were more likely to have reported taking bupropion than mothers of control infants (adjusted odds ratio, 2.6; 95% confidence interval, 1.2–5.7; P = .01).

      Conclusion

      We identified a positive association between early pregnancy bupropion use and left outflow tract heart defects; however, the magnitude of the observed increased risk was small. Nevertheless, further studies are needed to confirm these results.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ascher J.A.
        • Cole J.O.
        • Colin J.N.
        • et al.
        Bupropion: a review of its mechanism of antidepressant activity.
        J Clin Psychiatry. 1995; 56: 395-401
        • Hurt R.D.
        • Sachs D.P.
        • Glover E.D.
        • et al.
        A comparison of sustained-release bupropion and placebo for smoking cessation.
        N Engl J Med. 1997; 337: 1195-1202
        • Wisner K.L.
        • Gelenberg A.J.
        • Leonard H.
        • Zarin D.
        • Frank E.
        Pharmacologic treatment of depression during pregnancy.
        JAMA. 1999; 282: 1264-1269
        • Tong V.T.
        • England L.J.
        • Dietz P.M.
        • Asare L.A.
        Smoking patterns and use of cessation interventions during pregnancy.
        Am J Prev Med. 2008; 35: 327-333
        • Coleman T.
        Recommendations for the use of pharmacological smoking cessation strategies in pregnant women.
        CNS Drugs. 2007; 21: 983-993
      1. GlaxoSmithKline Bupropion Pregnancy Registry. Final report: 1 September 1997 through 31 March 2008. Registry Report. Wilmington, NC, 2008.

      2. Bupropion (amfebutamone): caution during pregnancy.
        Prescrire Int. 2005; 14: 225
        • Cole J.A.
        • Modell J.G.
        • Haight B.R.
        • Cosmatos I.S.
        • Stoler J.M.
        • Walker A.M.
        Bupropion in pregnancy and the prevalence of congenital malformations.
        Pharmacoepidemiol Drug Saf. 2007; 16: 474-484
        • Yoon P.W.
        • Rasmussen S.A.
        • Lynberg M.C.
        • et al.
        The National Birth Defects Prevention Study.
        Public Health Rep. 2001; 116: 32-40
        • Botto L.D.
        • Lin A.E.
        • Riehle-Colarusso T.
        • Malik S.
        • Correa A.
        National Birth Defects Prevention Study.
        Birth Defects Res A Clin Mol Teratol. 2007; 79: 714-727
        • Waller D.K.
        • Shaw G.M.
        • Rasmussen S.A.
        • et al.
        National Birth Defects Prevention Study.
        Arch Pediatr Adolesc Med. 2007; 161: 745-750
        • Frieden I.J.
        • Reese V.
        • Cohen D.
        PHACE syndrome: the association of posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities.
        Arch Dermatol. 1996; 132: 307-311
        • Alwan S.
        • Reefhuis J.
        • Rasmussen S.A.
        • Olney R.S.
        • Friedman J.M.
        National Birth Defects Prevention Study.
        N Engl J Med. 2007; 256: 2684-2692
        • Reller M.D.
        • Strickland M.J.
        • Riehle-Colarusso T.
        • Mahle W.T.
        • Correa A.
        Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005.
        J Pediatr. 2008; 153: 807-813
        • Lewin M.B.
        • McBride K.L.
        • Pignatelli R.
        • et al.
        Echocardiographic evaluation of asymptomatic parental and sibling cardiovascular anomalies associated with congenital left ventricular outflow tract lesions.
        Pediatrics. 2004; 114: 691-696
        • Chun-Fai-Chan B.
        • Koren G.
        • Fayez I.
        • et al.
        Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study.
        Am J Obstet Gynecol. 2005; 192: 932-936
        • Tucker W.E.
        Preclinical toxicology of bupropion: an overview.
        J Clin Psychiatry. 1983; 44: 60-62
        • Diav-Citrin O.
        • Shechtman S.
        • Weinbaum D.
        • et al.
        Paroxetine and fluoxetine in pregnancy: a prospective, multicenter, controlled, observational study.
        Br J Clin Pharmacol. 2008; 66: 695-705
        • Louik C.
        • Lin A.E.
        • Werler M.M.
        • Hernández-Díaz S.
        • Mitchell A.A.
        First-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects.
        N Engl J Med. 2007; 356: 2675-2683
        • Källén B.A.
        • Otterblad Olausson P.
        Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations.
        Birth Defects Res A Clin Mol Teratol. 2007; 79: 301-308
        • Berard A.
        • Ramos E.
        • Rey E.
        • Blais L.
        • St-Andre M.
        • Oraichi D.
        First trimester exposure to paroxetine and risk of cardiac malformations in infants: the importance of dosage.
        Birth Defects Res B Dev Reprod Toxicol. 2007; 80: 18-27
        • Cole J.A.
        • Ephross S.A.
        • Cosmatos I.S.
        • Walker A.M.
        Paroxetine in the first trimester and the prevalence of congenital malformations.
        Pharmacoepidemiol Drug Saf. 2007; 16: 1075-1085
        • Wogelius P.
        • Norgaard M.
        • Gislum M.
        • et al.
        Maternal use of selective serotonin reuptake inhibitors and risk of congenital malformations.
        Epidemiology. 2006; 17: 701-704