Which SSRI is contraindicated during pregnancy due to increased risk of cardiac malformations?

Paroxetine is associated with an increased risk of cardiac malformations when used during pregnancy, particularly in the first trimester. Numerous studies have indicated that exposure to paroxetine during early pregnancy can lead to a higher incidence of congenital heart defects, making it particularly concerning for pregnant patients. The risk factors associated with this medication have led to recommendations against its use in pregnant women unless absolutely necessary.

In contrast, other selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, citalopram, and sertraline are generally considered to have a more favorable safety profile in pregnancy. While they may still carry some risk of adverse outcomes, they are not specifically linked to the notable increase in cardiac malformations seen with paroxetine, which solidifies its contraindication during pregnancy. Thus, the heightened awareness and caution regarding paroxetine in pregnant patients underscore the importance of selecting safer alternatives for the management of depression and anxiety in this population.